Evaluation of the Impact of a Less-Invasive Trunk and Pelvic Trauma Protocol on Mortality in Patients with Severe Injury by Interrupted Time-Series Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting and Protocol
2.2. Study Population
2.3. Data Collection
2.4. Outcome Definition
2.5. Statistical Analysis
3. Results
3.1. Patient Flow Chart and Descriptive Analysis
3.2. Trends in the Study Period and ITSA Results
3.3. Secondary Analysis Using Individual Data: Before-and-After Comparative Study Design
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All Patients | Before Protocol | After Protocol | ||
---|---|---|---|---|
Patients’ Characteristics | n = 4558 | n = 2659 | n = 1899 | p-Value |
Age, years, median (IQR) | 66 (48–78) | 67 (49–79) | 64 (48–77) | 0.008 |
Male, n (%) | 2942 (64.5) | 1614 (60.7) | 1328 (69.9) | <0.001 |
Type of injury (%) | ||||
Crash | 638 (14.0) | 331 (12.4) | 307 (16.2) | NA |
Fall | 204 (4.5) | 92 (3.5) | 112 (5.9) | |
Traffic accident | 2062 (45.2) | 1100 (41.4) | 962 (50.7) | |
Other trauma | 1654 (36.3) | 1136 (42.7) | 518 (27.3) | |
ISS, median (IQR) | 16 (9–25) | 13 (9–24) | 19 (13–29) | <0.001 |
RTS, median (IQR) | 7.84 (7.55–7.84) | 7.84 (7.55–7.84) | 7.84 (7.55–7.84) | 0.014 |
TRISS, median (IQR) | 0.97 (0.91–0.97) | 0.97 (0.93–0.97) | 0.96 (0.89–0.97) | <0.001 |
Abdomen AIS, median (IQR) | 0 (0–1) | 0 (0–0) | 0 (0–2) | <0.001 |
Pelvic AIS, median (IQR) | 2 (1–3) | 2 (1–3) | 1 (1–3) | <0.001 |
Thoracic AIS, median (IQR) | 0 (0–3) | 0 (0–3) | 3 (0–4) | <0.001 |
Multiple trauma, n (%) | 1170 (25.7) | 548 (20.6) | 622 (32.8) | <0.001 |
Mechanical ventilation at the emergency department, n (%) | 681 (14.9) | 353 (13.3) | 328 (17.3) | <0.001 |
Use of medical response vehicle or air ambulance, n (%) | 794 (17.4) | 378 (14.2) | 416 (21.9) | <0.001 |
Coefficient | 95% CI | p-Value | |
---|---|---|---|
Impact of the protocol on in-hospital deaths (primary outcome) | |||
Time change | −0.0036 | −0.12 to 0.11 | 0.95 |
Level change | −1.49 | −4.82 to 1.84 | 0.39 |
Trend change | −0.044 | −0.22 to 0.14 | 0.63 |
Impact of the protocol on in-hospital deaths (according to sensitivity analysis of the primary outcome) | |||
Time change | −0.035 | −0.14 to 0.067 | 0.50 |
Level change | −1.18 | −4.15 to 1.79 | 0.44 |
Trend change | −0.08 | −0.239 to 0.079 | 0.33 |
TRISS | −54.1 | −81.0 to −27.2 | <0.001 |
Impact of the protocol on the number of IVR procedures (secondary outcome) | |||
Time change | 0.09 | −0.03 to 0.21 | 0.151 |
Level change | 8.01 | 4.48 to 11.53 | <0.001 |
Trend change | −0.35 | −0.54 to −0.17 | <0.001 |
All Patients | Before Protocol | After Protocol | ||
---|---|---|---|---|
Clinical Outcomes | n = 4558 | n = 2659 | n = 1899 | p-Value |
Death, n (%) | 361 (7.9) | 240 (9.0) | 121 (6.4) | 0.001 |
Emergent IVR, n (%) | 237 (5.2) | 70 (2.6) | 167 (8.8) | <0.001 |
Operation or IVR on the day of admission (%) | 1703 (37.4) | 1170 (44.0) | 533 (28.1) | <0.001 |
Preventable trauma deaths, n (%) | 179 (3.9) | 113 (4.2) | 66 (3.5) | 0.001 |
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Ishida, T.; Iwasaki, Y.; Yamamoto, R.; Tomita, N.; Shinohara, K.; Kawamae, K.; Yamauchi, M. Evaluation of the Impact of a Less-Invasive Trunk and Pelvic Trauma Protocol on Mortality in Patients with Severe Injury by Interrupted Time-Series Analysis. Medicina 2024, 60, 1338. https://doi.org/10.3390/medicina60081338
Ishida T, Iwasaki Y, Yamamoto R, Tomita N, Shinohara K, Kawamae K, Yamauchi M. Evaluation of the Impact of a Less-Invasive Trunk and Pelvic Trauma Protocol on Mortality in Patients with Severe Injury by Interrupted Time-Series Analysis. Medicina. 2024; 60(8):1338. https://doi.org/10.3390/medicina60081338
Chicago/Turabian StyleIshida, Tokiya, Yudai Iwasaki, Ryohei Yamamoto, Nozomi Tomita, Kazuaki Shinohara, Kaneyuki Kawamae, and Masanori Yamauchi. 2024. "Evaluation of the Impact of a Less-Invasive Trunk and Pelvic Trauma Protocol on Mortality in Patients with Severe Injury by Interrupted Time-Series Analysis" Medicina 60, no. 8: 1338. https://doi.org/10.3390/medicina60081338