The effect of trauma advanced practice nurse programme at a Level I regional trauma centre in mainland China.

This was a single-centre before-and-after study, not a randomised trial, so other changes in trauma care over time may have contributed to the results. The pre-programme and post-programme groups were not identical at baseline: age and Revised Trauma Score differed, although gender, arrival GCS score and injury mechanism were comparable. The text and Table 3 give different emergency department and ICU length of stay figures, so the exact magnitude of reduction is unclear. Some time-efficiency indicators were not significantly different, including time to advanced airway establishment. The authors did not evaluate physician or patient satisfaction or non-technical skills. The programme was tested in a large Level I centre in eastern China, so it may not transfer directly to resource-limited areas.

Do not conclude that the advanced practice nurse role alone caused faster care or better survival. The study compared patient groups before and after a bundled programme that included trauma clinical practice, registry and databank management, trauma nursing education, a time flow chart, team activation and data audit. The contribution of any single component cannot be separated. This was a before-and-after study with no randomised concurrent control group, and the survival finding was a secondary analysis while the overall emergency department outcome distribution was not statistically significant.