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Article ; Online: National Neurotrauma Registry Data in Low- and Middle-Income Countries - Current Status and Future Requirements Comment on "Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries".

Lecky, Fiona

International journal of health policy and management

2023 Volume 12, Page(s) 7935

Abstract: Since 1990 National Trauma Registries, - taking the form of "not for profit" small and medium enterprises - have been integral to improvementsin major injury case fatality in high-income settings. This is laudable but unsatisfactory as globally most ... ...

Abstract	Since 1990 National Trauma Registries, - taking the form of "not for profit" small and medium enterprises - have been integral to improvementsin major injury case fatality in high-income settings. This is laudable but unsatisfactory as globally most years of life lost to injury occur in low- and middle-income countries (LMICs).
MeSH term(s)	Humans ; Developing Countries ; Routinely Collected Health Data ; Registries ; Income
Language	English
Publishing date	2023-05-02
Publishing country	Iran
Document type	Review ; Journal Article ; Comment
ZDB-ID	2724317-5
ISSN	2322-5939 ; 2322-5939
ISSN (online)	2322-5939
ISSN	2322-5939
DOI	10.34172/ijhpm.2023.7935
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Article ; Online: Should plasma GFAP guide the management of patients with traumatic brain injury and a negative CT scan?

Lecky, Fiona

The Lancet. Neurology

2019 Volume 18, Issue 10, Page(s) 908–909

MeSH term(s)	Brain Injuries, Traumatic ; Humans ; Magnetic Resonance Imaging ; Prospective Studies ; Tomography, X-Ray Computed
Language	English
Publishing date	2019-08-23
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2079704-7
ISSN	1474-4465 ; 1474-4422
ISSN (online)	1474-4465
ISSN	1474-4422
DOI	10.1016/S1474-4422(19)30327-8
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Article ; Online: Association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales.

Tonkins, Michael / Bouamra, Omar / Lecky, Fiona

Emergency medicine journal : EMJ

2023 Volume 40, Issue 4, Page(s) 257–263

Abstract: Background: Disability and death due to low falls is increasing worldwide and disproportionately affects older adults. Current trauma systems were not designed to suit the needs of these patients. This study assessed the association between major trauma ...

Abstract	Background: Disability and death due to low falls is increasing worldwide and disproportionately affects older adults. Current trauma systems were not designed to suit the needs of these patients. This study assessed the association between major trauma centre (MTC) care and outcomes in adult patients injured by low falls. Methods: Data were obtained from the Trauma Audit and Research Network on adult patients injured by falls from <2 m between 2017 and 2019 in England and Wales. 30-day survival, length of hospital stay and discharge destination were compared between MTCs and trauma units or local emergency hospitals (TU/LEHs) using an adjusted multiple logistic regression model. Results: 127 334 patients were included, of whom 27.6% attended an MTC. The median age was 79.4 years (IQR 64.5-87.2 years), and 74.2% of patients were aged >65 years. MTC care was not associated with improved 30-day survival (adjusted OR (AOR) 0.91, 95% CI 0.87 to 0.96, p<0.001). Transferred patients had a significant impact on the results. After excluding transferred patients, MTC care was associated with greater odds of 30-day survival (AOR 1.056, 95% CI 1.001 to 1.113, p=0.044). MTC care was also associated with greater odds of 30-day survival in the most severely injured patients (AOR 1.126, 95% CI 1.04 to 1.22, p=0.002), but not in patients aged >65 years (AOR 1.038, 95% CI 0.982 to 1.097, p=0.184). Conclusion: MTC care was not associated with improved survival compared with TU/LEH care in the whole cohort. Patients who were transferred had a significant impact on the results. In patients who are not transferred, MTC care is associated with greater odds of 30-day survival in the whole cohort and in the most severely injured patients. Future research must determine the optimum means of identifying patients in need of higher-level care, the components of care which improve patient outcomes, develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients, and investigate the need for transfer in specific subgroups of patients.
MeSH term(s)	Humans ; Aged ; Trauma Centers ; Wales/epidemiology ; Length of Stay ; England/epidemiology ; Outcome Assessment, Health Care ; Wounds and Injuries/epidemiology ; Wounds and Injuries/therapy ; Retrospective Studies ; Injury Severity Score
Language	English
Publishing date	2023-02-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2022-212393
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Article ; Online: Towards exploring current challenges and future opportunities relating to the prehospital triage of patients with traumatic brain injury: a mixed-methods study protocol.

Alqurashi, Naif / Alotaibi, Ahmed / Bell, Steve / Lecky, Fiona / Body, Richard

BMJ open

2023 Volume 13, Issue 3, Page(s) e068555

Abstract: Introduction: Traumatic brain injury (TBI) is a major global health burden that results in disability and loss of health. Identifying those patients who require specialist neuroscience care can be challenging due to the low accuracy of existing ... ...

Abstract	Introduction: Traumatic brain injury (TBI) is a major global health burden that results in disability and loss of health. Identifying those patients who require specialist neuroscience care can be challenging due to the low accuracy of existing prehospital trauma triage tools. Despite the widespread use of decision aids to 'rule out' TBI in hospitals, they are not widely used in the prehospital environment. We aim to provide a snapshot of current prehospital practices in the UK, and to explore facilitators and challenges that may be encountered when adopting new tools for decision support. Methods and analysis: A mixed-methods study will be conducted using a convergent design approach. In the first phase, we will conduct a national survey of current practice in which every participating ambulance service in the UK will receive an online questionnaire, and only one response is required. In the second phase, semistructured interviews will be conducted to explore the perceptions of ambulance service personnel regarding the implementation of new triage methods that may enhance triage decisions. The survey questions and the interview topic guide were piloted and externally reviewed. Quantitative data will be summarised using descriptive statistics; qualitative data will be analysed thematically. Ethics and dissemination: This study has been approved by the Health Research Authority (REC reference 22/HRA/2035). Our findings may inform the design of future care pathways and research as well as identify challenges and opportunities for future development of prehospital triage tools for patients with suspected TBI. Our findings will be published in peer-reviewed journals, relevant national and international conferences, and will be included in a PhD thesis.
MeSH term(s)	Humans ; Triage ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/therapy ; Patients ; Ambulances ; Critical Pathways
Language	English
Publishing date	2023-03-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-068555
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Article ; Online: Head injury: assessment and early management-summary of updated NICE guidance.

Rajesh, Sharangini / Wonderling, David / Bernstein, Ian / Balson, Caroline / Lecky, Fiona

BMJ (Clinical research ed.)

2023 Volume 381, Page(s) 1130

MeSH term(s)	Humans ; Craniocerebral Trauma/diagnosis ; Craniocerebral Trauma/therapy ; Tomography, X-Ray Computed
Language	English
Publishing date	2023-05-30
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.p1130
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Article ; Online: Severe trauma with associated pelvic fractures: The impact of regional trauma networks on clinical outcome.

Kanakaris, Nikolaos K / Bouamra, Omar / Lecky, Fiona / Giannoudis, Peter V

Injury

2023

Abstract: Lately, the care of severely injured patients in the United Kingdom has undergone a significant transformation. The establishment of regional trauma networks (RTN) with designated Major Trauma Centers (MTCs) and satellite hospitals called Trauma Units ( ... ...

Abstract	Lately, the care of severely injured patients in the United Kingdom has undergone a significant transformation. The establishment of regional trauma networks (RTN) with designated Major Trauma Centers (MTCs) and satellite hospitals called Trauma Units (TUs) has centralized the care of severely injured patients in the MTCs. Pelvic fractures are notoriously linked with hypovolemic shock or even death from excessive blood loss. The aim of this prospective cohort study is to compare the profile of severely injured patients with combined pelvic fractures and their mortality between two different distinct eras of an advanced healthcare system. Anonymized consecutive patient records submitted to TARN UK between 2002 and 2017 by NHS England hospitals were analyzed. Records of patients without a pelvic fracture, or with isolated pelvic fractures (no other serious injury with abbreviated injury scale AIS >2) were excluded. All patients with known outcomes were included and were divided into 2 distinct periods (pre-RTN era: between January 2002 and March 2008 (control group); and RTN era April 2013 to June 2017 (study group)). Data from the transition period from April 2008 to March 2013 were excluded to minimize the effect of variations between the developing networks and MTCs during that era. Overall, the study group included 10,641 patients, whereas the control group was 3152 patients, with a median age of 52.4 and 35.1 years and an ISS of 24 and 27 respectively. A systolic blood pressure below 90mmHg was observed in 7.2% of patients in the study group and 10.4% in the control group. A significant increase of the median time to death (from 8hrs to 188hrs) was observed between the two eras. The cumulative mortality of severely injured patients with pelvic fractures decreased significantly from 17.8% to 12.4% (p<0.0001). The recorded improvement of survivorship in the subgroup of severely injured patients with a pelvic fracture (32% lower in the post-RTN than in the pre-RTN period: OR 1.32 (95% CI 1.21 - 1.44), following the first 5 years of established regional trauma networks in NHS England, is encouraging, and should be attributed to a wide range of factors that translate to all levels of trauma care.
Language	English
Publishing date	2023-04-13
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.04.006
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Article ; Online: Patient controlled analgesia in the emergency department.

Lecky, Fiona

BMJ (Clinical research ed.)

2015 Volume 350, Page(s) h3240

MeSH term(s)	Abdominal Pain/therapy ; Analgesia, Patient-Controlled ; Emergency Treatment ; Female ; Humans ; Male ; Pain/etiology ; Pain Management/methods ; Wounds and Injuries/complications
Language	English
Publishing date	2015-06-21
Publishing country	England
Document type	Comment ; Editorial
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.h3240
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Article ; Online: Twenty-five years of the trauma audit and research network: a continuing evolution to drive improvement.

Lecky, Fiona

Emergency medicine journal : EMJ

2015 Volume 32, Issue 12, Page(s) 906–908

MeSH term(s)	Cause of Death ; Clinical Audit/methods ; Clinical Audit/standards ; Humans ; Injury Severity Score ; Quality Assurance, Health Care/methods ; Quality Improvement ; State Medicine ; Time Factors ; Trauma Centers/standards ; Trauma Centers/trends ; Traumatology/standards ; Traumatology/trends ; United Kingdom
Language	English
Publishing date	2015-12
Publishing country	England
Document type	Editorial
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2015-205460
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Article ; Online: The CRASH3 study: prehospital TXA for every injured patient?

Coats, Timothy J / Lecky, Fiona E

Emergency medicine journal : EMJ

2020 Volume 37, Issue 6, Page(s) 392–394

MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Antifibrinolytic Agents/standards ; Antifibrinolytic Agents/therapeutic use ; Craniocerebral Trauma/drug therapy ; Emergency Medical Services/methods ; Emergency Medical Services/standards ; Emergency Medical Services/statistics & numerical data ; Female ; Glasgow Coma Scale ; Humans ; Male ; Middle Aged ; Placebos ; Tomography, X-Ray Computed/methods ; Tomography, X-Ray Computed/trends ; Tranexamic Acid/standards ; Tranexamic Acid/therapeutic use
Chemical Substances	Antifibrinolytic Agents ; Placebos ; Tranexamic Acid (6T84R30KC1)
Language	English
Publishing date	2020-03-27
Publishing country	England
Document type	Editorial
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2019-209264
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Article ; Online: Defining major trauma: a Delphi study.

Thompson, Lee / Hill, Michael / Lecky, Fiona / Shaw, Gary

Scandinavian journal of trauma, resuscitation and emergency medicine

2021 Volume 29, Issue 1, Page(s) 63

Abstract: Introduction: Retrospective 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 ... ...

Abstract	Introduction: Retrospective 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. Method: A 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. Results: Of 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. Conclusion: Based 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".
MeSH term(s)	Consensus ; Delphi Technique ; Humans ; Male ; Middle Aged ; Research Design ; Retrospective Studies ; Wounds and Injuries/diagnosis
Language	English
Publishing date	2021-05-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-021-00870-w
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