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T J Coats

Publications and source records attributed to T J Coats.

At least 37 records · Page 2Linked to original sources
PubMed2001

Mathematical modelling of patients flow through an accident and emergency department.

OBJECTIVES: The objectives of this project; (1) to evaluate the method, (2) to assess the information required for a more detailed model, and (3) to determine if it was worthwhile to undertake the data collection needed for a more detailed model. METHODS: A mathematical model was constructed using the operational research method of discreet event simulation. The effect of different SHO shift patterns on waiting time was assessed with the model. RESULTS: The model constructed was not an accurate representation of patient flow because of the large number of assumptions that had to be made in this preliminary model. However, the model predicted that an SHO shift pattern that more closely matched the patient arrival pattern would produce shorter waiting times. CONCLUSIONS: This method can be applied to an accident and emergency department. Extension of this approach with the collection of additional data and the development of more sophisticated models seems worthwhile.

Data Collection↗
PubMed2000

The timing of disability measurements following injury.

Disability following trauma has profound personal, social and economic costs. Currently, measurement of disability is not standardised and no agreed time interval between injury and disability measurement exists. This study was designed to define the best time at which to measure disability following trauma. The functional independence measurement (FIM) and Glasgow outcome scale (GOS) were assessed at 3, 6, 12 and more than 24 months after injury for 201 trauma patients. The best time to measure was defined as the point at which a steady state was reached, i.e. when further functional improvement ceased. Motor FIM showed significant change between 3 and 6 month assessments (p < 0.002) and 6 and 12 months (p < 0.002). No statistically significant change occurred beyond 12 months (p > 0.02). For Cognitive FIM, there was significant change between 3 and 6 months (p = 0.02), but not beyond 6 months (p > 0.2). For GOS there was significant change between 3 and 6 months (p < 0.002) and 6 and 12 months (p < 0.002) but not beyond 12 months (p > 0.2). Disability measurements should be performed 12 months after injury, when patients have reached a steady state. This time of measurement should be adopted as the standard for trauma databases and outcome studies.

Adolescent↗
PubMed2000

Audit of time to emergency trauma laparotomy.

BACKGROUND: An analysis of the process of care may improve quality of care within a trauma system. Early operative control of haemorrhage is vital and any delay before surgery may adversely affect outcome. METHODS: Times from activation of the aeromedical team to arrival in the emergency department and the operating room for patients with liver or spleen injury were analysed to identify factors that delayed laparotomy. These results were compared with those of a national database. RESULTS: The median time from emergency call to operation was 127 min (140 min for blunt and 86 min for penetrating injuries). Time from arrival in the emergency department to the operating room was 54 min (56 min for blunt and 37 min for penetrating injuries). An audit filter, set at the upper quartile of the emergency call to operating room time, selected 21 patients whose records were examined; five correctable delays were identified. Compared with the national trauma database, these patients had longer on-scene times, but significantly shorter times to operation from the emergency call (127 versus 161 min) and arrival at the emergency department (54 versus 115 min), although the patients were more severely injured (median Injury Severity Score 34 versus 24). CONCLUSION: The time to emergency trauma laparotomy may be used effectively as an audit of process for the clinical governance of a trauma system. Presented to the British Trauma Society, Bath, October 1997 and the Faculty of Accident and Emergency Medicine, Glasgow, December 1997, and published in abstract form as J Accid Emerg Med 1998; 15: 134

Adult↗
PubMed2000

Radiography versus spiral CT in the evaluation of cervicothoracic junction injuries in polytrauma patients who have undergone intubation.

A prospective study was performed over a 1-year period in patients who had sustained blunt trauma, mostly in motor vehicle accidents. All 73 patients (56 male and 17 female; age range, 2-94 years; mean age, 35.2 years) in the study had undergone intubation and ventilation at the trauma site (mean Glasgow Coma Score, 9.9 [range, 3-15]; mean Injury Severity Score, 30.4 [range, 8-75]) and subsequently underwent three-view radiography of the cervical spine and thin-section spiral computed tomography (CT) of the cervicothoracic junction. Spinal fractures were detected in 20 patients and involved the cervicothoracic junction region in 12 cases. In all 12 patients, the fractures were visualized at CT, whereas in seven of 12 patients, conventional radiography failed to demonstrate injuries (transverse process fracture of T1 [n = 1], pedicle and vertebral body fracture of C7 [n = 1], fractures of the first and second ribs [n = 5]). Thus, routine CT of the cervicothoracic junction in a highly select group of severely injured patients helped detect occult fracture in seven of 73 patients (10%); however, most of these fractures were not clinically significant. Larger studies involving a high-risk patient population are needed to confirm these findings.

Accidents, Traffic↗
PubMed2000

Sonoclot coagulation analysis of in-vitro haemodilution with resuscitation solutions.

The colloid and crystalloid solutions used for resuscitation should preferably be free from effects on coagulation. In 10 volunteers, the effects of haemodilution with various concentrations of 0.9% sodium chloride and 4% succinylated gelatin were assessed by Sonoclot analysis, which describes the whole coagulation process. Small and moderate haemodilution (up to 40%) with 0.9% sodium chloride promoted coagulation. Similar haemodilution with 4% succinylated gelatin impaired coagulation, and at 60% haemodilution coagulation was very poor. These findings need to be confirmed in vivo and their clinical relevance determined.

Blood Coagulation↗
PubMed1999

Identification of patients to include in trauma audit: a modification of the pre-chart.

Trauma audit is commonly focused using a Pre-Chart to illustrate calculations made using the TRISS model. A line is drawn at Ps = 0.5 to divide expected survivors and nonsurvivors. The use of this cut-off in a severely injured population was examined. The 'M statistic' for a group of injured patients selectively triaged to a Trauma Centre was calculated. The ideal cut-off point between predicted outcomes when using the TRISS model to focus trauma audit in this population was determined using a Receiver Operating Characteristic (ROC) curve. For this population the TRISS 'M statistic' was 0.71 (indicating a significantly different case mix from the reference database) and the best cut-off point was at Ps = 0.76. Trauma audit in populations with a case mix of injury severity different from the reference database should use a different Ps line to define unexpected outcomes.

Humans↗
PubMed1999

On scene thoracotomy: a case report.

We report a case of on scene resuscitative thoracotomy performed by an anaesthetist on a patient in cardiac arrest following a stab wound to the chest. The patient made a good recovery and was discharged from hospital within 2 weeks. The rationale for performing resuscitative thoracotomy and who should perform this procedure are discussed.

Adult↗
PubMed1999

In-hospital resuscitation--what should we be teaching?

This paper examines the initial actions that should take place following the sudden collapse of a patient in a hospital. The current Basic Life Support guidelines are not designed for this situation, yet are commonly taught to hospital staff. An alternative algorithm for Hospital Resuscitation has been developed. Additional factors, such as the recognition of the sick patient and the importance of audit should be included in hospital resuscitation training. A tiered approach to resuscitation training within a hospital should be adopted and national standards developed.

Algorithms↗
PubMed1999

Outcome after severe head injury treated by an integrated trauma system.

OBJECTIVES: To describe outcome after treatment of severe head injury within an integrated trauma system. METHODS: A retrospective analysis of all patients with severe head injury admitted to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) between 1991 and 1994. Type of injury was defined on initial computed tomography of the head and outcomes assessed 12 months after injury using the Glasgow outcome score. RESULTS: 6.5% of HEMS patients had long term severe disability (severe disability or persistent vegetative state on the outcome score); 34.5% made a good recovery. CONCLUSIONS: The concern that a large number of severely disabled long term survivors might result as a consequence of this system of trauma management is not confirmed. The case mix of severity of extracranial injuries in these patients makes comparison with other published series difficult, but these data fit the hypothesis that pre-hospital correction of hypoxia and hypotension after head injury improves outcome.

Abbreviated Injury Scale↗
PubMed1998

Early changes in middle cerebral artery blood flow velocity after head injury.

OBJECT: This study was designed to investigate the incidence of early abnormalities in the cerebral circulation after head injury by relating the results of the initial computerized tomography (CT) scan with transcranial Doppler (TCD) ultrasound readings to see if the side of injury and the outcome can be predicted by using these modalities. METHODS: Transcranial Doppler ultrasound measurements were obtained in the emergency room in 22 head-injured patients less than 3 hours after injury. The middle cerebral artery (MCA) was insonated using a standard technique. The TCD measurements in each MCA were examined individually; of 39 measurements, 22 (56%) showed a low mean blood flow velocity, 27 (69%) demonstrated a high pulsatility index (PI), and 18 (46%) showed both abnormalities. The side of the cerebrovascular abnormality measured by TCD ultrasound did not appear to be an accurate predictor of the side of the injury as determined on the initial CT scan. Of 13 patients in whom either a space-occupying hematoma or signs of swelling were shown on the initial CT scan, 10 (77%) had an increased PI in one or both MCAs, which is an indication of high flow resistance. CONCLUSIONS: Transcranial Doppler ultrasound examinations performed while patients are in the emergency room may have a role in determining treatment priorities, especially in those with multiple injuries.

Abbreviated Injury Scale↗
PubMed1997

Interpretation of the Ws statistic: application to an integrated trauma system.

BACKGROUND: Comparison of trauma survival rates between institutions and reference data bases is hampered by different injury severity mixes. To overcome this, a standardized comparison using a stratified W statistic (Ws) has been proposed. Ws enables comparisons but does not represent actual survival rates at an institution. METHOD, DISCUSSION, AND RESULTS: This discussion paper uses, as an example, data from 632 patients with blunt injuries treated by an integrated trauma system comprising a helicopter emergency medical service and the Royal London Hospital. Using the United Kingdom Major Trauma Outcome Study as a reference data set, Ws is calculated and its usefulness discussed. The problem of overprediction of survival is discussed. A modification of the Ws method is used to allow for this and to estimate the actual survival rate. CONCLUSION: Ws is useful for comparison between centers. Trauma and Injury Severity Score methodology overpredicts survival in certain probability of survival intervals. Adjustment can be made to estimate the actual survival rate. When applied to an integrated trauma system, such adjustments demonstrate overall improved survival, most noticeable in a more severely injured subgroup.

Diagnosis-Related Groups↗
PubMed1996

'Efficient' timely evacuation of intracranial haematoma--the effect of transport direct to a specialist centre.

Patients with intracranial haematoma following head injury may have little primary brain injury, but sustain a secondary brain injury that can often be minimized by early evacuation of the haematoma. Rapid intervention by a neurosurgeon with early evacuation of the haematoma gives a better outcome. The timing of treatment in 403 patients with severe head injuries, admitted to the Royal London Hospital between January 1991 and December 1994 was examined. All cases had been transported directly from the accident scene by the Helicopter Emergency Medical Service because the local hospital did not have neurosurgical facilities. The median time to medical intervention was 15 min (95 per cent, confidence interval (CI) 14-16) and the median time to neurosurgery was 177 min (95 per cent, CI 171-195). As secondary interhospital transfer of patients with head injuries is known to increase the time to neurosurgical intervention and is a time of great risk of secondary insult to the brain, transfer direct from the scene of the accident to an appropriate centre allows a process of care that has been shown to be associated with a better outcome.

Brain Injuries↗
PubMed1996

Children falling from a height in London.

OBJECTIVES: To determine the frequency and geographical distribution of children falling from a height in London and to suggest possible causes and preventative measures. METHODS: All relevant cases attended by the Helicopter Emergency Medical Service (HEMS) in a three and a half year period were reviewed and the locations related to the boroughs. The rates, per 1,000 resident children, were compared with socioeconomic indices for the boroughs concerned. In addition, a survey was undertaken of window fittings and maintenance in high rise flats close to one particular incident. RESULTS: A total of 90 incidents were attended involving 91 patients (64 male, 27 female) of whom five died. HEMS attends approximately one third of incidents involving serious trauma. In the study period the maximum frequency was 0.2 fallers per 1,000 resident children, occurring in three boroughs. In three boroughs there were no fallers. There was no overlap in socioeconomic indices between the five boroughs with the highest fall rates and the five with the lowest. The building survey found a high incidence of faulty window catches, a slow response rate for repair, and a lack of safety advice for residents. CONCLUSIONS: The frequency of falling is related to urban deprivation, poor maintenance, and lack of safety information. A combination of regulation and targeted education could substantially decrease deaths and injuries in children from this cause.

Accidental Falls↗
PubMed1995

Pre-hospital management of patients with severe thoracic injury.

The physiological variables of oxygen saturation, blood pressure and pulse rate were compared in the pre-hospital phase and on arrival at hospital in a group of 63 patients with severe chest injury. Eighty-nine pre-hospital thoracic drainage procedures were carried out. Pre-hospital Advanced Trauma Life Support (ATLS) was associated with a significant improvement in all three variables. Median oxygen saturation increased by 17 per cent (P < 0.001), median blood pressure increased from 90 to 120 mmHg (P < 0.001) and median pulse rate decreased from 125 to 105 (P < 0.001). Pre-hospital intervention is indicated for tension pneumothorax, and contraindicated for haemothorax without respiratory compromise. In other situations further evidence is required, and standard ATLS protocols should be used until this is available.

Adolescent↗