Timeliness of Management of Trauma Related Hemorrhage and Trauma Related Coagulopathy

创伤相关出血和创伤相关凝血障碍的及时处理

• 批准号: 10641870
• 负责人: Anne M Stey
• 金额: $ 18.53万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641870
• 关键词: Accident and Emergency department; Adherence; Age Years; Algorithms; American; American College of Surgeons; Anticoagulants; Area; Bleeding time procedure; Blood Coagulation Disorders; Blood Pressure; Blood Transfusion; Caring; Cause of Death; Cessation of life; Chicago; Clinical; Clinical Data; Clinical Trials; Data; Data Science; Devices; Emergency Medical Technicians; Emergency medical service; Engineering; Ensure; Failure; Future; Goals; Guidelines; Health; Healthcare Systems; Hemorrhage; Hemostatic Agents; Hospitals; Hour; Illinois; Injury; Intervention; Interventional radiology; K-Series Research Career Programs; Knowledge; Laboratories; Learning; Life; Machine Learning; Maps; Methods; Minor; Operative Surgical Procedures; Outcomes Research; Patient Care; Patient Transfer; Patient Triage; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Physiological; Practice Management; Procedures; Process; Protocols documentation; Provider; Randomized, Controlled Trials; Research; Resources; Resuscitation; Standardization; System; Testing; Time; Training; Trauma; Trauma patient; Traumatic injury; Triage; United States; Work; blood product; clinical care; data modeling; data registry; design; high risk; hospital care; improved; injured; mortality; patient oriented; pilot test; prevent; preventable death; programs; prototype; severe injury; standardized care; stroke patient; supervised learning; time use; trauma care; trauma centers; trauma surgery; user centered design

PROJECT SUMMARY Injury is the most common cause of death in people younger than 46 years of age, and bleeding after injury is the most common cause of preventable death. Treatment of bleeding requires timely procedures to stop the bleeding as well as medications and blood transfusions to prevent blood thinning. Hospitals that specialize in treating injury have protocols, medications, devices and clinical staff available 24 hours a day and seven days a week. Injured people treated at specialized hospitals are more likely to live. However, there are far too many injured people every year than can be treated at specialized hospitals so minor injuries are cared for at hospitals not specialized in treating injuries. Severely injured people are taken to hospitals not specialized in treating injuries when specialized hospitals are too far away, or the emergency medical personnel underestimate how seriously injured someone is. Hospitals not specialized in treating injuries do not participate in ongoing injury clinical trials, regional data registries nor national quality improvement programs, and as a result what happens there that leads to people bleeding to death is unknown. This application's long-term objective is to improve the timeliness of treatment of bleeding after injury. The Specific Aims will be to: 1) understand how bleeding after injury is managed in hospitals that do and do not specialize in treating injuries; 2) identify the reasons patients do not get timely treatment; and3) determine how to improve the timeliness of treatment. The central hypothesis is that treatment of bleeding is not standardized in hospitals not specialized in treating injuries and leads to a delay in transferring injured people to specialized hospitals. Identifying modifiable healthcare system, hospital, and patient factors can inform the design of a systematic process to quickly temporarily stabalize bleeding of injured people initially at non-specialized centers then expedite transfer to specialized hospitals by engaging key stakeholders from across the spectrum of hospitals. This will ensure that people who are bleeding after injury are cared for at the right place at the right time. Ultimately, the right treatment at the right time will give people initially taken to hospitals not specialized in treating injuries the same chance at life as those taken to specialized hospitals. As a Career Development Award, the proposed training plan will include training in data science, systems engineering and design. The methods to be learned and employed will be machine learning, failure mode, effects and criticality analysis and user-centered design. The health relatedness of the project is to understand current practice management of bleeding after injury, in order to improve the timeliness of bleeding treatments to enhance the health of injured inviduals.

项目概要 受伤是 46 岁以下人群最常见的死亡原因，受伤后出血是 可预防死亡的最常见原因。治疗出血需要及时采取措施来止血 出血以及药物和输血以防止血液稀释。专科医院 提供 7 天、每天 24 小时提供治疗损伤的方案、药物、设备和临床人员 一周。在专门医院接受治疗的伤员更有可能存活。然而，有太多 每年都有很多受伤的人无法在专门医院接受治疗，因此轻伤会在专业医院接受治疗 不专门治疗伤害的医院。重伤者被送往非专业医院 当专科医院距离太远或急救人员太远时治疗受伤 低估某人受伤的严重程度。非专业治疗伤害的医院不参与 在正在进行的损伤临床试验、区域数据登记或国家质量改进计划中，并作为 结果，那里发生了什么导致人们失血过多致死的情况尚不清楚。此应用程序是长期的 目的是提高伤后出血治疗的及时性。具体目标是：1) 了解专门治疗和不治疗损伤的医院如何处理损伤后出血； 2）找出患者没有得到及时治疗的原因； 3) 确定如何提高及时性 治疗。中心假设是非专业医院的出血治疗不规范 伤者的治疗，并导致将伤者转移到专科医院的延误。识别 可修改的医疗保健系统、医院和患者因素可以为系统流程的设计提供信息，以 最初在非专业中心迅速暂时稳定伤者的出血，然后加快速度 通过与各医院的主要利益相关者合作，将其转移到专科医院。这将 确保受伤后流血的人在正确的时间在正确的地点得到护理。最终， 在正确的时间进行正确的治疗将使最初被送往非专门治疗伤害的医院的人们 与被送往专科医院的人一样有机会获得生命。作为职业发展奖，拟议 培训计划将包括数据科学、系统工程和设计方面的培训。需要学习的方法 并采用机器学习、故障模式、影响和关键性分析以及以用户为中心的设计。 该项目与健康的相关性是了解当前受伤后出血的管理实践， 为了提高出血治疗的及时性，以增强受伤人员的健康。

项目成果

Geographic Disparities in Re-triage Destinations Among Seriously Injured Californians.

重伤加州人重新分诊目的地的地理差异。

• DOI: 10.1097/as9.0000000000000270
• 发表时间: 2023
• 期刊: Annals of surgery open : perspectives of surgical history, education, and clinical approaches
• 作者: Furmanchuk,Al'ona;Rydland,KelseyJames;Hsia,ReneeY;Mackersie,Robert;Shi,Meilynn;Hauser,MarkWilliam;Kho,Abel;Bilimoria,KarlY;Stey,AnneM
• 通讯作者: Stey,AnneM

Maternal Critical Care: The Story Behind the Numbers.

孕产妇重症监护：数字背后的故事。

• DOI: 10.1213/ane.0000000000005823
• 发表时间: 2022
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Toledo,Paloma;Nelson,LaTashaD;Stey,Anne
• 通讯作者: Stey,Anne

Does Trauma Center Volume Account for the Association Between Trauma Center Verification Level and In-Hospital Mortality among Children Injured by Firearms in California?

创伤中心的数量是否可以解释创伤中心验证水平与加利福尼亚州枪械致伤儿童的院内死亡率之间的关联？

• DOI: 10.1097/xcs.0000000000000818
• 发表时间: 2023
• 期刊: Journal of the American College of Surgeons
• 影响因子: 5.2
• 作者: Sullivan,GwynethA;Reddy,Susheel;Reiter,AudraJ;Zeineddin,Suhail;Visenio,Michael;Hu,Andrew;Mackersie,Robert;Kabre,Rashmi;Raval,MehulV;Stey,AnneM
• 通讯作者: Stey,AnneM

Defining obstacles to emergency transfer of trauma patients: An evaluation of retriage processes from nontrauma and lower-level Illinois trauma centers.

• DOI: 10.1016/j.surg.2022.08.027
• 发表时间: 2022-12
• 期刊: SURGERY
• 影响因子: 3.8
• 作者: Slocum, John D.;Holl, Jane L.;Love, Remi;Shi, Meilynn;Mackersie, Robert;Alam, Hasan;Loftus, Timothy M.;Andersen, Rebecca;Bilimoria, Karl Y.;Stey, Anne M.
• 通讯作者: Stey, Anne M.

The gap between hospital-based violence intervention services and client needs: A systematic review.

基于医院的暴力干预服务与客户需求之间的差距：系统评价。

• DOI: 10.1016/j.surg.2023.07.011
• 发表时间: 2023
• 期刊: Surgery
• 影响因子: 3.8
• 作者: Jang,Angie;Thomas,Arielle;Slocum,John;Tesorero,Kaithlyn;Danna,Giovanna;Saklecha,Anjay;Wafford,Eileen;Regan,Sheila;Stey,AnneM
• 通讯作者: Stey,AnneM