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Pseudofracture: An Acute Peripheral Tissue Trauma Model
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Does mortality after trauma team activation peak at shift change?

Morgan Schellenberg1, Natthida Owattanapanich1, Lindsey Karavites1

  • 1Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
|May 11, 2022
PubMed
Summary

Trauma mortality is higher during early morning shift changes, linked to patient severity, not system factors. Optimizing resources during this critical period may improve care for trauma team activations (TTA).

Keywords:
MortalityProvider response timesShift changeTime to interventionTrauma team activation

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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Healthcare Systems Analysis

Background:

  • Institutional data indicate peak trauma mortality occurs during the 06:00-07:59 window.
  • This period coincides with the 07:00-07:30 healthcare provider shift change.
  • Previous studies highlight the need to investigate factors influencing outcomes during this specific time.

Purpose of the Study:

  • To define patient, provider, and systems variables associated with trauma mortality.
  • To analyze outcomes for trauma team activations (TTA) arriving during shift change (SC) versus non-shift change (NSC) periods.
  • To identify factors contributing to increased mortality during the early morning shift change.

Main Methods:

  • Retrospective analysis of all TTA patients at an ACS-verified Level I trauma center (01/2008-07/2019).
  • Patients were categorized into SC (06:00-07:59) and NSC groups based on arrival time.
  • Univariable, multivariable, and propensity score analyses were employed to compare variables and outcomes.

Main Results:

  • The SC group (229 patients) had a significantly higher mortality rate (25%) compared to the NSC group (16%).
  • SC patients presented with more severe injuries, indicated by lower SBP (<90) and GCS (<9), and higher Injury Severity Score (ISS).
  • After propensity score matching, no significant difference in mortality was observed between SC and NSC groups, suggesting patient factors, not system factors, drive the disparity.

Conclusions:

  • Early morning represents a low-volume, high-mortality period for TTAs.
  • Increased mortality during shift change is independently associated with patient and injury severity, not provider or systems factors.
  • Strategic allocation of clinical resources during this high-acuity period is recommended to enhance patient care and outcomes.