Back to Search Start Over

Clinical impact of a prehospital trauma shock bundle of care in South Africa

Authors :
Nee-Kofi Mould-Millman
Julia M. Dixon
Bradley van Ster
Fabio Moreira
Beatrix Bester
Charmaine Cunningham
Shaheem de Vries
Brenda Beaty
Krithika Suresh
Steven G. Schauer
Joseph K. Maddry
Lee A. Wallis
Vikhyat S. Bebarta
Adit A. Ginde
Source :
African Journal of Emergency Medicine, Vol 12, Iss 1, Pp 19-26 (2022)
Publication Year :
2022
Publisher :
Elsevier, 2022.

Abstract

Introduction: Patients experiencing traumatic shock are at a higher risk for death and complications. We previously designed a bundle of emergency medical services traumatic shock care (“EMS-TruShoC”) for prehospital providers in resource-limited settings. We assess how EMS-TruShoC changes clinical outcomes of critically injured prehospital patients. Methods: This is a quasi-experimental educational implementation of a simplified bundle of care using a pre-post design with a control group. The intervention was delivered to EMS providers in Western Cape, South Africa. Delta shock index (heart rate divided by systolic blood pressure, reported as change from the scene to facility arrival) from the 13 months preceding intervention were compared to the 13 months post-implementation. A difference-in-differences analysis examined the difference in mean shock index change between the groups. Results: Data were collected from 198 providers who treated 770 severe trauma patients. The patient groups had similar demographic and clinical characteristics at baseline. Over all time-points, both groups had an increase in mean delta shock index (worsening shock), with the largest difference occurring 4-months post-implementation (0.047 change in control arm, 0.004 change in intervention arm; −0.043 difference-in-differences, P = 0.27). In pre-specified subgroup analyses, there was a statistically significant improvement in delta shock index in the intervention arm in patients with penetrating trauma cared for by basic providers immediately post-implementation (−0.372 difference-in-differences, P = 0.02). Discussion: Overall, there was no significant difference in delta shock index between the EMS-TruShoC intervention versus control groups. However, significant improvement in shock index in one subgroup suggests the intervention may be more likely to benefit penetrating trauma patients and basic providers.

Details

Language :
English
ISSN :
2211419X
Volume :
12
Issue :
1
Database :
Directory of Open Access Journals
Journal :
African Journal of Emergency Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.943fe0611a90492d961c91fcb33bfdd0
Document Type :
article
Full Text :
https://doi.org/10.1016/j.afjem.2021.10.003