Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital

Lovely, R.G.; Trecartin, Andrew; Ologun, Gabe; Johnston, Alexander; Svintozelskiy, Sergy; Vermeylen, Françoise; Thiel, D H Van; Golden, Daniel W.; Casós, Steven R.; Granet, Jason; Behm, Robert

doi:10.1080/15389588.2018.1532217

Cited by 13 publications

(10 citation statements)

References 3 publications

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“…Trauma mechanism and bodily injuries Most studies included any trauma mechanism, commonly defined as external force to the body not including bites, stings, burns, or drownings. A specific mechanism of injury was stated in the inclusion criteria in relatively few studies, and mechanism was often either "blunt" [49,66,98,109] or "penetrating" [58,97,101], though some did look at motor vehicle collisions as a specific mechanism [48,77]. There were several studies that focused on isolated torso injuries [25,79], but overall, the majority of articles (73, 76%) included any trauma mechanism to any body part.…”

Section: Resultsmentioning

confidence: 99%

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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

et al. 2020

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Background Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation. Main body We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure. Conclusion The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.

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Section: Resultsmentioning

confidence: 99%

“…Interventional prehospital trauma studies on this topic were rare. Last, studies primarily assessing the association of prehospital time and in-hospital mortality reported mixed (i.e., positive, negative, and neutral) associations, with conflicting conclusions [28,30,36,40,41,56,65,68,70,77,114].…”

Section: Discussionmentioning

confidence: 99%

A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

et al. 2020

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“…The percentages of population in towns or cities with EMS may explain, at least in part, the shorter response times and transport times in rural EMS 7.3 (Jaraíz de la Vera) and EMS 4.3 (Azuaga), which are the towns with EMS and with the highest percentage of population with respect to the total EMS area population (33.4 and 32.8%, respectively; Table 1). However, the response time and the transport time are not always significant predictors of hospital mortality, while the Injury Severity Score (ISS) predicts mortality independent of scene time or transport time for patients who arrive to the hospital alive following a motor vehicle collision [13].…”

Section: Discussionmentioning

confidence: 99%

“…The database with all the information on traffic accidents for the period 2012-2015 was provided by the management team of the ERCC-112 and part of its analysis has been published elsewhere [10,11]. The response time or reporting-scene time is defined as the time interval between the notification to ERCC-112 and the EMS arrival on the scene [12,13]. This time is comparable to the so-called medical response time in other studies [14,15].…”

Section: Data Extractionmentioning

confidence: 99%

Geographical Distribution of Emergency Services Times in Traffic Accidents in Extremadura

Morales-Gabardino

Redondo-Lobato

Ribeiro

et al. 2021

Port J Public Health

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Objective: To analyze the response time and transport time taken by the emergency medical services (EMS), considering their urban or rural location, to attend traffic accident casualties that occurred in the different geographical areas of Extremadura (Spain) from 2012 to 2015. Methods: This was a cross-sectional study of the data recorded by the Emergency Response Coordination Center 112 (ERCC-112) from traffic accidents attended by EMS. Response time was defined as the time elapsed from the request-for-care receipt until arrival of the EMS at the accident scene, and transport time as that from leaving the scene until arrival to the referral hospital. Rural EMS were those based in locations where there is no hospital, and urban EMS those located in towns or cities with a hospital. Results: During the 4-year period studied, 5,572 traffic accidents requested assistance through the ERCC-112. From the 2,875 accidents (51.9%) in which EMS were mobilized, 55.4% occurred in urban roads and the remaining in interurban ones. A total of 113 people (mean age 48.4 ± 19.0 years, range 15–84 years) died at the accident scene or before arrival to the hospital, 88.5% of them in interurban accidents. The average response time of urban and rural EMS was 10.7 ± 7.3 and 18.0 ± 12.6 min (p < 0.001), respectively, and the average transport time was 13.2 ± 11.7 and 45.2 ± 25.0 min (p = 0.009). Response time was longer than the 30-min optimum only in the most peripheral areas of Extremadura, while transport time exceeded the optimum of 90 min in the eastern regions of two health areas (Cáceres and Don Benito-Villanueva). 19.1% of the victims attended by rural EMS were classified as having a serious prognosis or as having died, as compared with 11.2% (p = 0.048) of those attended by urban EMS. Conclusions: The geographical location of EMS in Extremadura (Spain) guarantees adequate response times in traffic accidents, both in rural and urban areas. However, recommended transport times were occasionally exceeded in the most peripheral areas, due to hospital location.

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“…There are several scoring systems that are used to determine the severity and mortality of trauma cases, ISS is one of the most common scoring systems. ISS is the best system at predicting mortality, and an ISS score below 25 is an indicator of good outcome for TCA (9,19). Huber-Wagner et al (5) found that the mean ISS score was 41.0 for TCA patients, and Barnard et al (13) found it to be 29 (minimum-maximum: 21-75).…”

Section: Discussionmentioning

confidence: 99%

Analysis of traumatic cardiorespiratory arrest cases in a level 3 emergency department

Acar¹,

Bilge²

2020

GMJ

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Our study aims to investigate the return of spontaneous circulation (ROSC) outcomes in traumatic arrest patients that were admitted to the emergency department (ED).Methods: This study retrospectively investigates traumatic cardiorespiratory arrest (TCA) cases that were admitted to the level 3 ED of a university hospital between October 1, 2016 and April 30, 2019. The study includes TCA cases where cardiopulmonary resuscitation was performed in the preclinical phase, and/or after admission to the ED. Additional data were collected for statistical analysis: ROSC, age, gender, mechanism of injury, laboratory findings, injury severity scores (ISS), imaging methods, and consultation requests. The exclusion criteria were as follows: (a) non-traumatic arrest, (b) incomplete records.Results: A total of 41 TCA patients were included in the study. ROSC was achieved in 16 patients (39.0%). Ten subjects (24.4%) were female and 31 (75.6%) were male, and the mean age of the sample group was 46.56±26.49 years. ROSC did not significantly depend on gender or age (p=0.612, 0.064, respectively). Most of the traumatic injuries were in the head-neck region, the extremities, and the thorax. ROSC did not significantly depend on the mechanism of injury (p=0.620). ROSC was significantly correlated with ISS scores (p=0.006). Conclusion:According to our data, TCA mostly occur due to blunt trauma among the young adult male population and ISS scores seem useful in predicting ROSC. Trauma team formation should be directed to reversible causes of TCA, such as bleeding control, blood/blood product transfusions, and thoracostomy, to improve patient outcomes.

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Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital

Cited by 13 publications

References 3 publications

A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

Geographical Distribution of Emergency Services Times in Traffic Accidents in Extremadura

Analysis of traumatic cardiorespiratory arrest cases in a level 3 emergency department

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