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We hypothesized that most trauma providers are reticent to consider palliative measures early in acute trauma care, and that both patient and provider characteristics drive decisions about early transitions to comfort care.Īn IRB-approved electronic survey (QuestionPro Inc., San Francisco, CA, USA) was distributed to all current members of the Western Trauma Association (WTA) and the Eastern Association for the Surgery of Trauma (EAST) in October 2018 with permission of each association’s multicenter research chairperson or committee. The objective of this study was to investigate the clinical circumstances and trauma provider characteristics associated with a willingness to consider palliative care measures in the early management of acute trauma. 5 There is a paucity of literature concerning the willingness of trauma providers to consider this process in more acute settings, such as the emergency department (ED). For these reasons, the role of palliative care early in acute trauma management remains poorly defined and is often only considered after all other options have failed. Several groups have described the process of transitioning established trauma patients to comfort or palliative care approaches in the intensive care unit (ICU) setting.2, 3, 4 This approach can be challenging to integrate into contemporary acute trauma treatment algorithms, most of which are built to provide rapid, curative care to unstable patients, with less regard for intrusiveness and resource consumption. 1Ĭonversely, the principles of palliative and end-of-life care include symptom control and management of the psychological, social, and spiritual issues that may arise in patients with conditions that are chronic, fatal, or unresponsive to curative treatment. Further complicating matters, trauma patients are frequently unconscious, de-identified, and unaccompanied by an advance directive (AD) or next of kin decision-maker. These situations may offer little opportunity for discussion, clarification, or questions regarding goals of care. Trauma patients often arrive in extremis, mandating rapid decision-making and immediate, invasive treatment measures. There are over 5 million people in the US living with disability from TBI at an estimated cost of over $37.8 billion per year.The underlying ethos of acute trauma management errs on the side of aggressive, life-saving care.
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50,000 die (one third of all trauma deaths).1,000,000 people with TBI per year in US:.Traumatic Brain Injury (TBI) is the single largest cause of death from injury in the United States: World Report Summary on Road Traffic Injury Prevention, 2004, WHO and the World Bank.Predicted to become the third largest contributor to the global burden of disease by 2020.Road traffic crashes kill 1.2 million people annually around the world (3242 people a day) 90% of these deaths are in low or middle income countries.Traffic Safety Facts, 2005 from the NHTSA There were 43,443 deaths and 2.7 million injuries from motor vehicle crashes in the US in 2005.Suicide Fact Sheet from the NVIPC at CDC.There were over 30,000 suicides in the US in 2001.There are almost 40,000 homicide and suicide deaths each year in the US.Trauma is the fourth leading cause of death overall for all ages.Trauma is the leading cause of death for individuals up to the age of 45 years ( Table of Causes of Death)." Crashes NOT accidents." In the United States:
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Many of these strategies are well-established, easily available and relatively inexpensive, such as seat belts and helmets. Injury can be prevented and many lives saved by learning more about the causes of injury and implementing appropriate injury prevention strategies. The events which result in injury are not random or unpredictable. Around the world, injury is responsible for more than 5 million deaths per year. In the United States, injury accounts for over 150,000 deaths and over 3 million non-fatal injuries per year. To that end, injury prevention is an invaluable part of our efforts. It is critical that every effort be made to decrease the impact of injury on the global burden of the disease. This section of our website is designed to provide lay persons as well as health care workers with information about injury in the United States and around the world. The American Association for the Surgery of Trauma is committed to improving the care of the injured patient through education and research. Critical Care Committee Journal Reviews.Past Research and Education Scholarship Recipients.