Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study

Biswadev Mitra, Vineet Kumar, Gerard O'Reilly, Peter Cameron, Amit Gupta, Amol P Pandit, Kapil D Soni, Gaurav Kaushik, Joseph Mathew, Teresa Howard, Madonna Fahey, Michael Stephenson, Satish Dharap, Pankaj Patel, Advait Thakor, Naveen Sharma, Tony Walker, Mahesh C Misra, Russell L Gruen, Mark C Fitzgerald, Australia-India Trauma System Collaboration, Biswadev Mitra, Vineet Kumar, Gerard O'Reilly, Peter Cameron, Amit Gupta, Amol P Pandit, Kapil D Soni, Gaurav Kaushik, Joseph Mathew, Teresa Howard, Madonna Fahey, Michael Stephenson, Satish Dharap, Pankaj Patel, Advait Thakor, Naveen Sharma, Tony Walker, Mahesh C Misra, Russell L Gruen, Mark C Fitzgerald, Australia-India Trauma System Collaboration

Abstract

Objectives: To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes.

Design: Longitudinal prospective cohort study with preintervention and postintervention cohorts.

Setting: Major trauma centre in India.

Participants: Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories.

Intervention: A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care.

Main outcome measures: The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality.

Results: Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39).

Conclusions: The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India.

Trial registration number: NCT02877342.

Keywords: ambulance; mortality; notification; pre-hospital; wounds and injuries.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Screenshots of the application for prehospital notification. AVPU: Alert, Verbal, Pain, Unresponsive; SBP: Systolic Blood Pressure; ETA: Estimated time of arrival
Figure 2
Figure 2
Screenshot of the notification received at the hospital. RR, relative risk. AVPU: Alert, Verbal, Pain, Unresponsive; SBP: Systolic Blood Pressure; ETA: Estimated time of arrival; Inj Mech: Injury Mechanism; RTI: Road traffic incident
Figure 3
Figure 3
Selection of patients. ED, emergency department.

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Source: PubMed

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