Dataset Information

Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries.

ABSTRACT:

Objective

To compare experts' perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness.

Design

A mixed-methods approach using a multicentre online Delphi technique.

Setting

Two large tertiary hospitals in urban India.

Methods

Filters were rated on a scale from 1 to 10 in terms of perceived usefulness, with the option to add new filters and comments. The filters were categorised into three groups depending on their origin: low and middle-income countries (LMIC), WHO and New (locally developed), and their scores compared. Significance was determined using Kruskal-Wallis test followed by Wilcoxon rank-sum test. We performed a content analysis of the comments.

Results

26 predefined and 15 new filter suggestions were evaluated. The filters had high usefulness scores (mean overall score 9.01 of 10), with the LMIC filters having significantly higher scores compared with those from WHO and those newly added. Three themes were identified in the content analysis relating to medical relevance, feasibility and specificity.

Conclusions

Audit filters from other LMICs were deemed highly useful in the urban India context. This may indicate that the transferability of defined trauma audit filters between similar contexts is high and that these can provide a starting point when implemented as part of trauma quality improvement programmes in low-resource settings.

SUBMITTER: Berg J

PROVIDER: S-EPMC9185581 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries.

Berg Johanna J Alvesson Helle Molsted HM Roy Nobhojit N Ekelund Ulf U Bains Lovenish L Chatterjee Shamita S Bhattacharjee Prosanta Kumar PK David Siddarth S Gupta Swati S Kamble Jyoti J Khajanchi Monty M Lal Pawanindra P Malhotra Vikas V Meher Ravi R Mishra Anurag A Mohan Lakshmeswar Nagaraj LN Petzold Max M Saxena Ritu R Shrivastava Prabhat P Singh Rajdeep R Soni Kapil Dev KD Sural Sumit S Gerdin Wärnberg Martin M

BMJ open 20220609 6

<h4>Objective</h4>To compare experts' perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness.<h4>Design</h4>A mixed-methods approach using a multicentre online Delphi technique.<h4>Setting</h4>Two large tertiary hospitals in urban India.<h4>Methods</h4>Filters were rated on a scal ...[more]

PMID: 35680271

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Project description:BackgroundStudies from countries such as Australia and South Africa have demonstrated a difference in the types of injury managed in rural hospitals compared to larger, urban hospitals and so conclude staff require a different skill-set to work in these environments. There is some evidence this attitude may be prevalent amongst UK surgical trainees, resulting in difficulty recruiting to rural settings. In addition, studies have compared mortality in paediatric trauma patients in rural and urban hospitals, but none have described types of injury or orthopaedic operations required.We hypothesise the distribution of operative, orthopaedic paediatric trauma in a rural district general and an urban major trauma centre will not differ significantly in terms of patterns and mechanism of injury, orthopaedic intervention or time to theatre.Materials/methodsAll operative paediatric patients (0-15yrs) seen during an acute orthopaedic take at a rural district general and an urban major trauma centre were included. Non-operative admissions were excluded. Patients were identified using daily trauma work lists from each site. Outcomes were age, injury type, operation, time to theatre, seasonality and mechanism.Results183 patients from the urban hospital and 103 from the rural were identified. There were no significant differences found in age of patient, seasonality or time to theatre between cohorts (p > 0.05). There were also broadly similar patterns of injury and operations performed in both groups, although k-wiring was more often employed in the rural cohort than the urban (27% vs 17% of total operations). There were more bicycle and shinty related injuries in the rural cohort, and equine related in the urban.ConclusionsPaediatric trauma admissions do not vary significantly between rural and urban trauma centres, although the types of procedure performed may be less conservative in a rural hospital. This may be due to geography or differences in ED practice.

Project description:IntroductionRetrospective trauma scores are often used to categorise trauma, however, they have little utility in the prehospital or hyper-acute setting and do not define major trauma to non-specialists. This study employed a Delphi process in order to gauge degrees of consensus/disagreement amongst expert panel members to define major trauma.MethodA two round modified Delphi technique was used to explore subject-expert consensus and identify variables to define major trauma through systematically collating questionnaire responses. After initial descriptive analysis of variables, Kruskal-Wallis tests were used to determine statistically significant differences (p < 0.05) in response to the Delphi statements between professional groups. A hierarchical cluster analysis was undertaken to identify patterns of similarity/difference of response. A grounded theory approach to qualitative analysis of data allowed for potentially multiple iterations of the Delphi process to be influenced by identified themes.ResultsOf 55 expert panel members invited to participate, round 1 had 43 participants (Doctor n = 20, Paramedic n = 20, Nurse n = 5, other n = 2). No consistent patterns of opinion emerged with regards to professional group. Cluster analysis identified three patterns of similar responses and coded as trauma minimisers, the middle ground and the risk averse. Round 2 had 35 respondents with minimum change in opinion between rounds. Consensus of > 70% was achieved on many variables which included the identification of life/limb threatening injuries, deranged physiology, need for intensive care interventions and that extremes of age need special consideration. It was also acknowledged that retrospective injury severity scoring has a role to play but is not the only method of defining major trauma. Various factors had a majority of agreement/disagreement but did not meet the pre-set criteria of 70% agreement. These included the topics of burns, spinal immobilisation and whether a major trauma centre is the only place where major trauma can be managed.ConclusionBased upon the output of this Delphi study, major trauma may be defined as: "Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy mechanisms in those rendered vulnerable by extremes of age".

Project description:Discrimination is a type of social adversity defined as unfair treatment and prejudice against individuals due to membership of a specific group. Discrimination has been linked to several age-related outcomes such as cognitive decline, inflammation, and cardiovascular disease. However, the molecular drivers to these observations are poorly understood. Social adverse factors have been associated with proinflammatory and interferon gene expression, a phenomenon described as Conserved Transcriptome Response to Adversity. It is not known whether there are additional genes whose transcription is associated with exposure to discrimination among both African American and White adults. In this study, we have examined how perceived discrimination in African American and White adults affects genome-wide transcriptome differences using RNA sequencing. Perceived discrimination was measured based on responses to lifetime discrimination and racial discrimination questionnaires. Differential gene expression and pathway analysis was conducted in a cohort (N=59) stratified by race, sex, and discrimination exposure. We found that there were 28 significantly differentially expressed genes associated with high discrimination exposure in African American adults when compared to White adults with high discrimination exposure. The most significantly upregulated genes among African Americans with high discrimination exposure were related to immune function immunoglobulin lambda variable 2-11 (IGLV2-11), S100 calcium binding protein B (S100B), immunoglobulin kappa variable 3-20 (IGKV3-20), immunoglobulin kappa variable 4-1 (IGKV4-1); the most significantly downregulated genes were associated with immune modulation and cancer, lung cancer associated transcript 1 (LUCAT1), thrombospondin 1 (THBS1), and actin related protein 2/3 complex inhibitor (ARPIN). In addition, the most significantly upregulated Gene Ontology (GO) biological process among African American men with high exposure to discrimination compared to White male adults with high exposure to discrimination was regulation of cytokine biosynthetic processes. Conversely, immune response was the most significantly downregulated GO biological process among African American women with high discrimination exposure compared White women with high discrimination exposure. Understanding the biological pathways through which adverse social factors like discrimination affect gene expression will be critical in advancing knowledge of age-related health disparities.

Dataset Information

Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries.

Objective

Design

Setting

Methods

Results

Conclusions

Publications

Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries.

Similar Datasets

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