Basic Life Support Versus Advanced Life Support for Injured Patients With an Injury Severity Score of 10 or More

Cayten, C. Gene; Murphy, James G.; Stahl, William M.

doi:10.1097/00005373-199309000-00021

Cited by 65 publications

(53 citation statements)

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“…[20][21][22][23][24][25][26] These studies generally found no support for prehospital advanced life-support measures in major trauma. Although our study evaluated the package of interventions that is considered part of advanced life-support protocols, endotracheal intubation and intravenous fluid administration were the dominant elements of the protocols of care.…”

Section: Emergency Medical Services N = 2334 N = 532mentioning

confidence: 93%

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

Stiell¹

2005

Academic Emergency Medicine

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Background:To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established Methods:The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results:Among the 2867 patients enrolled in the basic lifesupport (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16). Interpretation:The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced lifesupport phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.

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Section: Emergency Medical Services N = 2334 N = 532mentioning

confidence: 93%

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

Stiell¹

2005

Academic Emergency Medicine

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“…Most studies were conducted and published in the United States (14,21,23,25,(27)(28)(29)(31)(32)(34)(35)(36)(37)(38)(39)(42)(43)(44)(45) ; so English was the most frequent language of the publications (14)(15)(16) .…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows predominance of retrospective (87.5%) (14)(15)(16)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) national multi-center studies (62,5%) (18)(19)(20)(22)(23)(25)(26)(27)(28)(29)(30)(31)(32)(33)35,38,(41)(42)(44)(45) , using databases as sources (81.3%) (19)(20)(21)…”

Section: Resultsmentioning

confidence: 99%

“…No study addressed penetrating trauma only. The most common population was of adult patients (n=18; 56.3%) (14)(15)(16)(17)(18)20,22,(24)(25)(29)(30)32,(35)(36)(38)(39)(42)(43) , followed by mixed adult and pediatric patients (n=6; 18.8%) (23,(26)(27)(28)31,37) . The sample size of studies ranged from 34 to 2,350,596 individuals; the most frequent samples had over 10,000 patients (40.6%) (22-23, 27-29, 32, 39-45) .…”

Section: Resultsmentioning

confidence: 99%

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Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

Domingues¹,

Nogueira

Settervall

et al. 2015

Rev. esc. enferm. USP

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RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

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“…These restrictions and the difficulty in pointing out the statistical association with the survival results maintains the controversy about EMS, mainly between rapidly removing the victim of the trauma scene to the hospital (scoop and run) or delivering care in the accident scene (scene stabilization) and, with this, delay the arrival to definitive care (1,3,(8)(9) . …”

Section: Introductionmentioning

confidence: 99%

Predetermining value analysis of the prehospital phase procedures in trauma victims survival

Malvestio¹,

Sousa

2008

Rev. Latino-Am. Enfermagem

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Basic Life Support Versus Advanced Life Support for Injured Patients With an Injury Severity Score of 10 or More

Cited by 65 publications

References 0 publications

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

Predetermining value analysis of the prehospital phase procedures in trauma victims survival

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