Critical Care Excellence in Sepsis and Trauma
Completed
Conditions studied: Sepsis, Trauma
In brief
The care of patients with sepsis and trauma requires the delivery of appropriate definitive care in the early stages of the illness. Hospitals with limited resources, those in rural and underserved areas of South Carolina, may be unable to consistently provide optimal care to these patients. In addition, the shortage of specialists nationally makes it more difficult for these hospitals to recruit and retain the specialists needed. Patients in these areas continue to pay the rural penalty of poorer outcomes. This study provides specialists' level care through telemedicine consults to rural emergency departments in rural areas of SC to improve outcomes for these patients. The CREST study is a project that specifically addresses the need to bring health care to rural communities in SC, as well as evaluates methods and tests technology to implement this care in rural communities. The CREST study uses telemedicine remotely from MUSC to rural community hospitals to provide rural community physicians care from specialists for trauma and sepsis, which are both high acuity, difficult to treat conditions. CREST is a multi-site trial of telemedicine services to meet rural patients' and providers' need for expert evaluation and management of sepsis and trauma. The specific aims of CREST are: 1. To test the hypothesis that a telemedicine program including education and clinical consultation between a tertiary care academic medical center and rural, local hospitals will significantly improve key treatment decisions and outcome measures in sepsis and trauma. 2. To test the hypothesis that the differences in ISS and time to antibiotics for trauma and sepsis patients exposed to telemedicine intervention and those without the intervention matched on propensity scores are not due to unmeasured confounders. CREST seeks new solutions to rural health disparities, to advance technology, create and retain jobs and address important research opportunities by combining implementation of a novel, trans disciplinary clinical program with rigorous, mixed methods scientific evaluation including clinical, process, and economic outcome measures. The impact on both science and quality healthcare outcomes is broad and CREST has far reaching implications for addressing rural health disparities for acute, life-threatening illnesses.
Key facts
- Study ID
- NCT01426711
- Run by
- Medical University of South Carolina
- People needed
- 26
- Starts
- 2009-09-01
- Expected to finish
- 2012-03-01
- Last updated by the study team
- 2018-04-30
Who can join
Age: 18 and older. Sex: any. Healthy volunteers: not accepted.
You may qualify if…
- Sepsis study patients are adult patients presenting to the rural hospital's EDs that meet the screening criteria for sepsis and two of four SIRS criteria.
- The screening criteria for possible sepsis are:
- known or suspected infection AND EITHER
- systolic blood pressure < 90mmHg after fluid challenge of 30mL/kg over 30 minutes OR
- lactate > 4mmol/L
- The screening criteria for possible SIRS are:
- abnormal core body temperature (<36.5 C or > 38 C)
- heart rate > 90 bpm
- respiratory insufficiency (respiratory rate > 20 breaths/min or PaCO2 < 32 mmHg or mechanical ventilation)
- abnormal white blood count (>12,000/cumm or < 4000/cumm)
- Trauma study patients are adult patients presenting to the rural hospital's EDs with blunt or penetrating injury and one or more of the following criteria:
- Respiratory insufficiency and/or intubation
- Glasgow coma scale < 8 with mechanism attributed to trauma
- Systolic blood pressure of <90mmHg
- Paralysis
- Penetrating injury to the head/neck/torso
- Crush to torso/upper thighs
- Major amputations
- Loss of consciousness > 5 minutes
- Maxillo-facial trauma
- Significant subcutaneous air
- Evidence of pelvic instability
- Two or more long bone deformities
- Major lacerations involving fascia
- Ejection from vehicle
You may not qualify if…
- The exclusion criteria for septic patients are:
- Age < 18 years
- The exclusion criteria for trauma patients are:
- Age < 18 years
- Burn injury of greater than 10% total body surface area
- Traumatic asphyxiation
- Lightning strike/electrical shock
- Patients undergoing cardiopulmonary resuscitation (CPR) on arrival
Where it is running
- Bamberg County Hospital — Bamberg, South Carolina, United States
- Barnwell County Hospital — Barnwell, South Carolina, United States
- Medical University of South Carolina — Charleston, South Carolina, United States
- Williamsburg Regional Medical Center — Kingstree, South Carolina, United States
- Regional Medical Center of Orangeburg — Orangeburg, South Carolina, United States
Full record on ClinicalTrials.gov
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