RESUMEN
BACKGROUND: Linked datasets for trauma system monitoring should ideally follow patients from the prehospital scene to hospital admission and post-discharge. Having a well-defined cohort when using administrative datasets is essential because they must capture the representative population. Unlike hospital electronic health records (EHR), ambulance patient-care records lack access to sources beyond immediate clinical notes. Relying on a limited set of variables to define a study population might result in missed patient inclusion. We aimed to compare two methods of identifying prehospital trauma patients: one using only those documented under a trauma protocol and another incorporating additional data elements from ambulance patient care records. METHODS: We analyzed data from six routinely collected administrative datasets from 2015 to 2018, including ambulance patient-care records, aeromedical data, emergency department visits, hospitalizations, rehabilitation outcomes, and death records. Three prehospital trauma cohorts were created: an Extended-T-protocol cohort (patients transported under a trauma protocol and/or patients with prespecified criteria from structured data fields), T-protocol cohort (only patients documented as transported under a trauma protocol) and non-T-protocol (extended-T-protocol population not in the T-protocol cohort). Patient-encounter characteristics, mortality, clinical and post-hospital discharge outcomes were compared. A conservative p-value of 0.01 was considered significant RESULTS: Of 1 038 263 patient-encounters included in the extended-T-population 814 729 (78.5 %) were transported, with 438 893 (53.9 %) documented as a T-protocol patient. Half (49.6 %) of the non-T-protocol sub-cohort had an International Classification of Disease 10th edition injury or external cause code, indicating 79644 missed patients when a T-protocol-only definition was used. The non-T-protocol sub-cohort also identified additional patients with intubation, prehospital blood transfusion and positive eFAST. A higher proportion of non-T protocol patients than T-protocol patients were admitted to the ICU (4.6% vs 3.6 %), ventilated (1.8% vs 1.3 %), received in-hospital transfusion (7.9 vs 6.8 %) or died (1.8% vs 1.3 %). Urgent trauma surgery was similar between groups (1.3% vs 1.4 %). CONCLUSION: The extended-T-population definition identified 50 % more admitted patients with an ICD-10-AM code consistent with an injury, including patients with severe trauma. Developing an EHR phenotype incorporating multiple data fields of ambulance-transported trauma patients for use with linked data may avoid missing these patients.
RESUMEN
PURPOSE: We determined whether the addition of hyoscine butylbromide (Buscopan) reduces the amount of opioid analgesia required and the need for ongoing opioid analgesia in acute renal colic. MATERIALS AND METHODS: Patients with a clinical diagnosis of acute renal colic were prospectively randomized to receive Buscopan or placebo in addition to morphine and intravenous fluids, with or without indomethacin. Observations and pain scores were recorded 15 every minutes during the first hour then hourly thereafter. Morphine was administered in 2.5 mg increments until pain relief was achieved. Recordings were ceased at 4 hours or on discharge from the emergency department, whichever occurred first. The diagnosis of renal colic was confirmed by computerized tomography. The dose of morphine (mg/kg) and the proportion of patients who required further morphine were compared between the 2 groups. RESULTS: Of the 192 patients randomized, data were available for 178 on an intent to treat basis. A total of 85 patients received Buscopan while 93 received placebo in addition to standard therapy. Patients in the Buscopan group required a median of 0.12 mg/kg of morphine while those in the placebo group received a median of 0.11 mg/kg, and this difference was not significant (p =0.4). There was also no significant difference in the proportion of patients who required additional morphine, 33% in the Buscopan group and 38% in the placebo group (p =0.5). Subgroup analysis of the 138 patients with a confirmed stone also showed no difference between the groups. CONCLUSIONS: There is no evidence that Buscopan reduces opioid requirements or the need for ongoing opioid analgesia in acute renal colic.
