RT Journal Article
SR Electronic
T1 Comparison of trauma care structures, processes and outcomes between the English National Health Service and Quebec, Canada
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP E32
OP E41
DO 10.1503/cjs.001822
VO 66
IS 1
A1 Samy Bouderba
A1 Fiona Lecky
A1 Kahina Soltana
A1 Xavier Neveu
A1 Dhushy Surendra Kumar
A1 Omar Bouamra
A1 Timothy J. Coats
A1 Pier-Alexandre Tardif
A1 Amina Belcaid
A1 Catherine Gonthier
A1 Lynne Moore
YR 2023
UL http://canjsurg.ca/content/66/1/E32.abstract
AB Background: Comparisons across trauma systems are key to identifying opportunities to improve trauma care. We aimed to compare trauma service structures, processes and outcomes between the English National Health Service (NHS) and the province of Quebec, Canada.Methods: We conducted a multicentre cohort study including admissions of patients aged older than 15 years with major trauma to major trauma centres (MTCs) from 2014/15 to 2016/17. We compared structures descriptively, and time to MTC and time in the emergency department (ED) using Wilcoxon tests. We compared mortality, and hospital and intensive care unit (ICU) length of stay (LOS) using multilevel logistic regression with propensity score adjustment, stratified by body region of the worst injury.Results: The sample comprised 36 337 patients from the NHS and 6484 patients from Quebec. Structural differences in the NHS included advanced prehospital medical teams (v. “scoop and run” in Quebec), helicopter transport (v. fixed-wing aircraft) and trauma team leaders. The median time to an MTC was shorter in Quebec than in the NHS for direct transports (1 h v. 1.5 h, p < 0.001) but longer for transfers (2.5 h v. 6 h, p < 0.001). Time in the ED was longer in Quebec than in the NHS (6.5 h v. 4.0 h, p < 0.001). The adjusted odds of death were higher in Quebec for head injury (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09–1.51) but lower for thoracoabdominal injuries (OR 0.69, 95% CI 0.52–0.90). The adjusted median hospital LOS was longer for spine, torso and extremity injuries in the NHS than in Quebec, and the median ICU LOS was longer for spine injuries.Conclusion: We observed significant differences in the structure of trauma care, delays in access and risk-adjusted outcomes between Quebec and the NHS. Future research should assess associations between structures, processes and outcomes to identify opportunities for quality improvement.