Mercier Eric, Cameron Peter A, Smith Karen, Beck Ben
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
BMJ Open. 2018 Jul 25;8(7):e022070. doi: 10.1136/bmjopen-2018-022070.
Regionalised trauma systems have been shown to improve outcomes for trauma patients. However, the evaluation of these trauma systems has been oriented towards in-hospital care. Therefore, the epidemiology and care delivered to the injured patients who died in the prehospital setting remain poorly studied. This study aims to provide an overview of a methodological approach to reviewing trauma deaths in order to assess the preventability, identify areas for improvements in the system of care provided to these patients and evaluate the potential for novel interventions to improve outcomes for seriously injured trauma patients.
The planned study is a retrospective review of prehospital and early in-hospital (<24 hours) deaths following traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria between 2008 and 2014. Eligible patients will be identified from the Victorian Ambulance Cardiac Arrest Registry and linked with the National Coronial Information System. For patients who were transported to hospital, data will be linked the Victoria State Trauma Registry. The project will be undertaken in four phases: (1) survivability assessment; (2) preventability assessment; (3) identification of potential areas for improvement; and (4) identification of potentially useful novel technologies. Survivability assessment will be based on predetermined anatomical injuries considered unsurvivable. For patients with potentially survivable injuries, multidisciplinary expert panel reviews will be conducted to assess the preventability as well as the identification of potential areas for improvement and the utility of novel technologies.
The present study was approved by the Victorian Department of Justice and Regulation HREC (CF/16/272) and the Monash University HREC (CF16/532 - 2016000259). Results of the study will be published in peer-reviewed journals and reports provided to Ambulance Victoria, the Victorian State Trauma Committee and the Victorian State Government Department of Health and Human Services.
区域创伤系统已被证明可改善创伤患者的治疗效果。然而，对这些创伤系统的评估一直侧重于院内护理。因此，对于在院前环境中死亡的受伤患者的流行病学情况及所接受的护理，仍研究不足。本研究旨在概述一种审查创伤死亡病例的方法，以评估其可预防性，确定为这些患者提供的护理系统中可改进的领域，并评估新型干预措施改善重伤创伤患者治疗效果的潜力。
计划开展的这项研究是对2008年至2014年间维多利亚州救护车服务机构接诊的院外创伤性心脏骤停后院前及早期院内（<24小时）死亡病例进行回顾性研究。符合条件的患者将从维多利亚州救护车心脏骤停登记处识别出来，并与国家死因信息系统相链接。对于被送往医院的患者，数据将与维多利亚州创伤登记处相链接。该项目将分四个阶段进行：（1）生存可能性评估；（2）可预防性评估；（3）确定潜在的改进领域；（4）确定潜在有用的新技术。生存可能性评估将基于预先确定的不可存活的解剖学损伤。对于有可能存活的损伤患者，将由多学科专家小组进行审查，以评估可预防性、确定潜在的改进领域以及新技术的实用性。
本研究已获得维多利亚州司法与监管部人类研究伦理委员会（CF/16/272）及莫纳什大学人类研究伦理委员会（CF16/532 - 2016000259）批准。研究结果将发表在同行评审期刊上，并向维多利亚州救护车服务机构提供报告，同时提供给维多利亚州创伤委员会以及维多利亚州政府卫生与公众服务部。
