Pre-hospital Notification of Injured Patients Presenting to Trauma Centres in India

Teresa Howard500 enrolled

Overview

A prospective observational study using an interrupted time-series design to evaluate the effect of pre-hospital notification on trauma patients arriving at a trauma centre by ambulance, in India

This is a longitudinal prospective cohort study of injured patients being transported by ambulance to the major trauma centre study sites. In the pre-intervention phase, prospective data on patients will be collected on pre-hospital assessment, notification, in-hospital assessment, management and outcomes and recorded in a new tailored multi-hospital trauma registry. All injured patients arriving by ambulance and allocated to a red or yellow priority category will be eligible for inclusion. The intervention will be a pre-hospital notification application in the form of an Android program that will be used by ambulance clinicians to notify emergency departments of selected hospitals of an impending arrival of a patient. The application will use a simple algorithm based on trauma triage principles developed by the Australia-India Trauma System Collaboration (AITSC). The proportion of severely injured patients arriving to hospital after notification will be the primary outcome measure with a target of 70%. Secondary outcomes evaluated will be availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest x-ray and in-hospital mortality.

Study Type

OBSERVATIONAL

Enrollment

500

Conditions

Major Trauma

Interventions

Pre-hospital notificationOTHER

Pre-hospital notification smartphone/tablet application in the form of an Android program that will be used by ambulance clinicians to notify emergency departments of selected hospitals of an impending arrival of a patient.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: All injured patients arriving by ambulance and allocated to a red (1st) or yellow (2nd) priority category will be eligible for inclusion. Data will be collected prospectively by trained data collectors positioned in the trauma centres. Retrospective inclusion will be continued for all screened patients presenting to any of the included hospitals with injury (including near-drowning) as the primary diagnosis and with at least one of the following criteria: 1. Admission to hospital 2. Death after triage but before admission 3. Dead on arrival Exclusion criteria: Patients meeting screening criteria will be subsequently excluded if they meet any of the following criteria: 1. Dead at scene 2. Alive at triage but not admitted to hospital (discharged alive) 3. Isolated poisoning 4. Isolated burns 5. Single digit finger or toe amputations (unless of the thumb or great toe), only

Locations (4)

Vadilal Sarabhai Hospital

Ahmedabad, Gujarat, India

RECRUITING

Guru Teg Bahadur Hospital

Delhi, India

RECRUITING

JPN Apex Trauma Centre at All India Institute of Medical Sciences

Delhi, India

RECRUITING

Outcomes

Primary Outcomes

Pre-hospital notification

Prior to arrival at emergency department. Pre-hospital notification will be the primary outcome, defined as a phone call or message to a treating hospital clinician regarding an injured patient enroute to hospital. For the purpose of this research project, a patient will satisfy primary outcome criteria if pre-hospital notification with any information has occurred. This variable will be collected and analysed as a binary variable.

Time frame: 1 - 1.5 years

Secondary Outcomes

Trauma Call out

A trauma callout occurs in response to the notification. A trauma call-out will be recorded as a binary variable- whether one has occurred or not.

Time frame: 1 - 1.5 years

Presence of trauma team leader

Trauma leader is present when the patient enters the emergency department for treatment. The presence of a trauma team leader at the time of patient arrival will be collected as a binary variable. This is the person whose role is to co-ordinate the trauma resuscitation

Time frame: 1 - 1.5 years

Readiness of trauma bay

At least 1 trauma bay that has been allocated and empty (therefore ready to receive a patient) on arrival.

Time frame: 1 - 1.5 years

Time to first chest x-ray

Time at which the first chest x-ray commenced will be recorded.

Time frame: 1 - 1.5 years

Location of patient discharge

The location to which a patient was discharged on completion of hospital management will be recorded

Time frame: 1 - 1.5 years