Trauma team leader and early mortality: An interrupted time series analysis - 24/11/22

Doi : 10.1016/j.ajem.2022.09.048

Jennifer Truchot, MD, PhD ^a,^b,^d, Axel Benhamed, MD, MSc ^a,^c,^d, Brice Batomen, PhD ^e, Valérie Boucher, MSc ^a, Christian Malo, MD, MSc ^a,^d, Jean-Marc Chauny, MD, MSc ^f,^g, François de Champlain, MD ^h,ⁱ, Marcel Émond, MD, MSc ^a,^d,^{^⁎}
^a CHU de Québec-Université Laval Research Centre, 1401 18e rue, QC G1J 1Z4, Canada
^b Emergency Department – SAMU 75, Cochin University Hospital- University of Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
^c Hospices Civils de Lyon, Service d'Accueil des Urgences – SAMU 69, Centre Hospitalier Universitaire Edouard Herriot, 5 Pl. d'Arsonval, 69003 Lyon, France
^d Faculté de Médecine, Université Laval, 1050 avenue de la Médecine, QC G1V 0A6, Canada
^e Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
^f Emergency Department, Hôpital du Sacre-Coeur de Montreal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada
^g Department of Family Medicine and Emergency Medicine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC H3C 3J7, Canada
^h Emergency Department, McGill University Health Centre, 1650 av. Cedar, Montreal, QC H3G 1A4, Canada
ⁱ Department of Emergency Medicine, McGill University, 845 Sherbrooke Street West, Montréal, QC H3A 0G4, Canada

^⁎Corresponding author at: CHU de Québec – Université Laval, Hôpital de l'Enfant-Jésus, 1401, 18e rue, H-608, QC G1J 1Z4, Canada.CHU de Québec – Université LavalHôpital de l'Enfant-Jésus1401, 18e rue, H-608QCG1J 1Z4Canada

Abstract

Background

The trauma team leader (TTL) is a “model” of a specifically dedicated team leader in the emergency department (ED), but its benefits are uncertain. The primary objective was to assess the impact of the TTL on 72-hour mortality. Secondary objectives included 24-hour mortality and admission delays from the ED.

Methods

Major trauma admissions (Injury Severity Score (ISS)≥12) in 3 Canadian Level-1 trauma centres were included from 2003 to 2017. The TTL program was implemented in centre 1 in 2005. An interrupted time series (ITS) analysis was performed. Analyses account for the change in patient case-mix (age, sex, and ISS). The two other centres were used as control in sensitivity analyses

Results

Among 20,193 recorded trauma admissions, 71.7% (n=14,479) were males. The mean age was 53.5 ± 22.0 years. The median [IQR] ISS was 22 [16–26]. TTL implementation was not associated with a change in the quarterly trends of 72-hour or 24-hour mortality: adjusted estimates with 95% CI were 0.32 [−0.22;0.86] and −0.07 [−0.56;0.41] percentage-point change. Similar results were found for the proportions of patients admitted within 8 hours of ED arrival (0.36 [−1.47;2.18]). Sensitivity analyses using the two other centres as controls yielded similar results.

Conclusion

TTL implementation was not associated with changes in mortality or admission delays from the ED. Future studies should assess the potential impact of TTL programs on other patient-centred outcomes using different quality of care indicators.

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Keywords : Trauma team, Mortality, Admission delays, Trauma care