Abstract
BACKGROUND We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 227-231 |
| Number of pages | 5 |
| Journal | Journal of Trauma and Acute Care Surgery |
| Volume | 79 |
| Issue number | 2 |
| DOIs | |
| State | Published - Aug 6 2015 |
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Keywords
- interventions
- lifesaving
- Prehospital
- scoop and run
- stay and play
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Surgery
Cite this
Decreased mortality after prehospital interventions in severely injured trauma patients. / Meizoso, Jonathan P.; Valle, Evan J.; Allen, Casey J.; Ray, Juliet J.; Jouria, Jassin M.; Teisch, Laura F.; Shatz, David V.; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G.
In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 2, 06.08.2015, p. 227-231.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Decreased mortality after prehospital interventions in severely injured trauma patients
AU - Meizoso, Jonathan P.
AU - Valle, Evan J.
AU - Allen, Casey J.
AU - Ray, Juliet J.
AU - Jouria, Jassin M.
AU - Teisch, Laura F.
AU - Shatz, David V.
AU - Namias, Nicholas
AU - Schulman, Carl I
AU - Proctor, Kenneth G
PY - 2015/8/6
Y1 - 2015/8/6
N2 - BACKGROUND We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.
AB - BACKGROUND We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.
KW - interventions
KW - lifesaving
KW - Prehospital
KW - scoop and run
KW - stay and play
UR - http://www.scopus.com/inward/record.url?scp=84938563843&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84938563843&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000000748
DO - 10.1097/TA.0000000000000748
M3 - Article
C2 - 26218690
AN - SCOPUS:84938563843
VL - 79
SP - 227
EP - 231
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 2
ER -