ABSTRACT
BACKGROUND: Cardiac arrests in admitted hospital patients with trauma have not been described in the literature. We defined "in-hospital cardiac arrest of a trauma" (IHCAT) patient as "cessation of circulatory activity in a trauma patient confirmed by the absence of signs of circulation or abnormal cardiac arrest rhythm inside a hospital setting, which was not cardiac re-arrest." This study aimed to compare epidemiology, clinical presentation, and outcomes between in- and out-of-hospital arrest resuscitations in trauma patients in Qatar. It was conducted as a retrospective cohort study including IHCAT and out-of-hospital trauma cardiac arrest (OHTCA) patients from January 2010 to December 2015 utilizing data from the national trauma registry, the out-of-hospital cardiac arrest registry, and the national ambulance service database. RESULTS: There were 716 traumatic cardiac arrest patients in Qatar from 2010 to 2015. A total of 410 OHTCA and 199 IHCAT patients were included for analysis. The mean annual crude incidence of IHCAT was 2.0 per 100,000 population compared to 4.0 per 100,000 population for OHTCA. The univariate comparative analysis between IHCAT and OHTCA patients showed a significant difference between ethnicities (p=0.04). With the exception of head injury, IHCAT had a significantly higher proportion of localization of injuries to anatomical regions compared to OHTCA; spinal injury (OR 3.5, 95% CI 1.5-8.3, p<0.004); chest injury (OR 2.62, 95% CI 1.62-4.19, p<0.00), and abdominal injury (OR 2.0, 95% CI 1.0-3.8, p<0.037). IHCAT patients had significantly higher hypovolemia (OR 1.66, 95% CI 1.18-2.35, p=0.004), higher mean Glasgow Coma Scale (GCS) score (OR 1.4, 95% CI 1.3-1.6, p<0.00), and a greater proportion of initial shockable rhythm (OR 3.51, 95% CI 1.6-7.7, p=0.002) and cardiac re-arrest (OR 6.0, 95% CI 3.3-10.8, p=<0.00) compared to OHTCA patients. Survival to hospital discharge was greater for IHCAT patients compared to OHTCA patients (OR 6.3, 95% CI 1.3-31.2, p=0.005). Multivariable analysis for comparison after adjustment for age and gender showed that IHCAT was associated with higher odds of spinal injury, abdominal injury, higher pre-hospital GCS, higher occurrence of cardiac re-arrest, and better survival than for OHTCA patients. IHCAT patients had a greater proportion of anatomically localized injuries indicating solitary injuries compared to greater polytrauma in OHTCA. In contrast, OHTCA patients had a higher proportion of diffuse blunt non-localizable polytrauma injuries that were severe enough to cause immediate or earlier onset of cardiac arrest. CONCLUSION: In traumatic cardiac arrest patients, IHCAT was less common than OHTCA and might be related to a greater proportion of solitary localized anatomical blunt injuries (head/abdomen/chest/spine). In contrast, OHTCA patients were associated with diffuse blunt non-localizable polytrauma injuries with increased severity leading to immediate cardiac arrest. IHCAT was associated with a higher mean GCS score and a higher rate of initial shockable rhythm and cardiac re-arrest, and improved survival rates.
ABSTRACT
INTRODUCTION: Healthcare research contributes to the well-being of a population; hence, it is important to use the right system to ensure that junior researchers develop the required skills. Current research-strengthening and capacity development programs might lack a research process-based common framework or model leading to variable and suboptimal outcomes. This study aimed to describe the development and evaluation of a model for health research-capacity development at both individual and institutional levels in a Joint Commission International-accredited governmental healthcare organization in Qatar. METHODS: This retrospective observational study evaluated a research support system employed in Qatar for 1 year and constituted of16 stations, each covering a different topic and supported by an experienced faculty member. We recorded how many faculty members were involved and how many people accessed which stations. We developed an outcomes logistic model and obtained feedback about their experience of using the research support system through a short survey. RESULTS: Twenty-one faculty members supported a total of 77 participants, representing various professions and specialties. The majority of the participants received support on multiple stations, and the most solicited were study design and methodology (n = 45, 58.4%) and research idea (n = 29, 37.7%). The most common type of research that participants required support for was clinical research (n = 65, 84.4%). Moreover, 58.4% of the participants answered the survey, and their responses attested to their perceived benefit of making use of the research support system. CONCLUSION: The research support system presented was positively evaluated by participants and promoted networking. Such aspects are favorable to the development of a research culture within an organization and would be a good addition for implementation in universities running healthcare programs and hospitals with residency programs and a large and varied healthcare workforce. This would contribute to the development of health-related research capacity and quality of research outputs in these institutions.
