Trauma Versus Nontrauma Intensive Care Unit Nursing: A Workload Comparison.

BACKGROUND: Trauma centers with dedicated trauma intensive care units (TICUs) have recently been developed in South Korea. It is hypothesized that TICU nurse staffing is driven not only by the number of patients but also by the work intensity. This study aims to compare nursing workload characteristics between TICUs and non-TICUs. METHODS: A 1-year retrospective study was performed in one TICU and five non-TICUs in a single trauma center from September 2014 to August 2015. Demographic data were collected along with nursing workload characteristics using the Workload Management System of Critical Care Nurses (WMSCN) score. RESULTS: A total of 332 trauma patients in the TICU and 2,346 nontrauma patients in non-TICUs were studied. TICU patients were younger (49.27 vs. 60.44, p < .001) and more frequently male (75.6% vs. 24.4%, p < .001). The most common admission reasons were motor vehicle crash (38.6%) and cardiovascular conditions (24.9%). Both intensive care unit and hospital length of stay were longer in TICU patients (12.72 vs. 5.43, p < .001; and 35.61 vs. 18.16, p < .001), whereas the mortality rates in the TICU were lower (11.1% vs. 15.1%, p < .001). Total WMSCN scores were significantly higher in the TICU (115.99 vs. 110.19; p < .001). CONCLUSIONS: This study found that nursing workload or work intensity was significantly higher in the TICU than in non-TICUs. Further multicenter studies using objective medical severity scores are warranted.

Erratum: Correction of Author Order: Reduced Mortality by Physician-Staffed HEMS Dispatch for Adult Blunt Trauma Patients in Korea.

This corrects the article on p. 1656 in vol. 31, PMID: 27550497.

Reduced Mortality by Physician-Staffed HEMS Dispatch for Adult Blunt Trauma Patients in Korea.

The aim of this study was to investigate the efficiency of domestic physician-staffed helicopter emergency medical service (HEMS) for the transport of patients with severe trauma to a hospital. The study included patients with blunt trauma who were transported to our hospital by physician-staffed HEMS (Group P; n = 100) or nonphysician-staffed HEMS (Group NP; n = 80). Basic patient characteristics, transport time, treatment procedures, and medical treatment outcomes assessed using the Trauma and Injury Severity Score (TRISS) were compared between groups. We also assessed patients who were transported to the hospital within 3 h of injury in Groups P (Group P3; n = 50) and NP (Group NP3; n = 74). The severity of injury was higher, transport time was longer, and time from hospital arrival to operation room transfer was shorter for Group P than for Group NP (P < 0.001). Although Group P patients exhibited better medical treatment outcomes compared with Group NP, the difference was not statistically significant (P = 0.134 vs. 0.730). However, the difference in outcomes was statistically significant between Groups P3 and NP3 (P = 0.035 vs. 0.546). Under the current domestic trauma patient transport system in South Korea, physician-staffed HEMS are expected to increase the survival of patients with severe trauma. In particular, better treatment outcomes are expected if dedicated trauma resuscitation teams actively intervene in the medical treatment process from the transport stage and if patients are transported to a hospital to receive definitive care within 3 hours of injury.

The Applicability of Trauma and Injury Severity Score for a Blunt Trauma Population in Korea and a Proposal of New Models Using Score Predictors.

PURPOSE: The purpose of this study was to verify the utility of existing Trauma and Injury Severity Score (TRISS) coefficients and to propose a new prediction model with a new set of TRISS coefficients or predictors. MATERIALS AND METHODS: Of the blunt adult trauma patients who were admitted to our hospital in 2014, those eligible for Korea Trauma Data Bank entry were selected to collect the TRISS predictors. The study data were input into the TRISS formula to obtain "probability of survival" values, which were examined for consistency with actual patient survival status. For TRISS coefficients, Major Trauma Outcome Study-derived values revised in 1995 and National Trauma Data Bank-derived and National Sample Project-derived coefficients revised in 2009 were used. Additionally, using a logistic regression method, a new set of coefficients was derived from our medical center's database. Areas under the receiver operating characteristic (ROC) curve (AUC) for each prediction ability were obtained, and a pairwise comparison of ROC curves was performed. RESULTS: In the statistical analysis, the AUCs (0.879-0.899) for predicting outcomes were lower than those of other countries. However, by adjusting the TRISS score using a continuous variable rather than a code for age, we were able to achieve higher AUCs [0.913 (95% confidence interval, 0.899 to 0.926)]. CONCLUSION: These results support further studies that will allow a more accurate prediction of prognosis for trauma patients. Furthermore, Korean TRISS coefficients or a new prediction model suited for Korea needs to be developed using a sufficiently sized sample.