Effectiveness of Physician-Led Prehospital Management in Severe Trauma Patients: A Retrospective Analysis of the Japanese Nationwide Trauma Registry

Abstract

Background: The comparative effectiveness of physician-led over paramedic-led prehospital trauma management has been inconclusive. Regarding this topic, in some previous studies, the impacts of physician-led prehospital management were affected by the advantage of shortened prehospital time by helicopter transportation. This study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time.Methods: This retrospective cohort study analyzed the data of severe trauma patients who were transported directly to a hospital during 2009–2018 using Japan’s nationwide trauma registry. In-hospital mortality was compared between patients who received physician-led prehospital management and those who received paramedic-led management, using 1:4 propensity score-matched analysis. The propensity score was calculated using information on patient demographics, mechanism of injury, and vital signs at the scene of injury, as well as prehospital transport time. Subgroup analysis was performed to identify patients who were most likely to benefit from physician-led prehospital management.Results: A total of 30,968 patients (physician-led: 3,032, paramedic-led: 27,936) were eligible for analysis, of whom 2,766 propensity score-matched pairs (i.e., physician-led: 2766, paramedic-led: 11,064) were generated and compared. Physician-led pre-hospital trauma management showed significant superiority over paramedic-led prehospital trauma management (in-hospital mortality: 395 [14.3%] and 1785 [16.1%], respectively; odds ratio [95% confidence interval] = 0.87 [0.77–0.97], p = 0.017). In subgroup analysis, cases characterized by patient age <65 years, Injury Severity Score ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and prehospital transport time <60 min likely benefitted from physician-led prehospital management.Conclusions: The result of a largescale registry-based cohort study showed that physician-led prehospital trauma management was significantly associated with survival benefit independent of prehospital transport time. The findings may provide a basis for future research to assess effective physician-provided treatments in prehospital-field.