Is Prehospital Time Important for the Treatment of Severely Injured Patients? A Matched-Triplet Analysis of 13,851 Patients from the TraumaRegister DGU®

Abstract

Background. The impact of time (the golden period of trauma) on the outcome of severely injured patients has been well known for a long time. While the duration of the prehospital phase has changed only slightly (average time: ~66 min) since the TraumaRegister DGU® (TR-DGU®) was implemented, mortality rates have decreased within the last 20 years. This study analyzed the influence of prehospital time on the outcome of trauma patients in a matched-triplet analysis. Material and Methods. A total of 93,024 patients from the TraumaRegister DGU® were selected based on the following inclusion criteria: ISS ≥ 16, primary admission, age ≥ 16 years, and data were available for the following variables: prehospital intubation, blood pressure, mode of transportation, and age. The patients were assigned to one of three groups: group 1: 10-50 min (short emergency treatment time); group 2: 51-75 min (intermediate emergency treatment time); group 3: >75 min (long emergency treatment time). A matched-triplet analysis was conducted; matching was based on the following criteria: intubation at the accident site, rescue resources, Abbreviated Injury Scale (AIS) of the body regions, systolic blood pressure, year of the accident, and age. Results. A total of 4,617 patients per group could be matched. The number of patients with a GCS score ≤8 was significantly higher in the first group (group 1: 36.6%, group 2: 33.5%, group 3: 30.3%; p < 0.001). Moreover, the number of patients who had to be resuscitated during the prehospital phase and/or upon arrival at the hospital was higher in group 1 (p = 0.010); these patients also had a significantly higher mortality (group 1: 20.4%, group 2: 18.1%, group 3: 15.9%; p ≤ 0.001). The number of measures performed during the prehospital phase (e.g., chest tube insertion) increased with treatment time. Conclusions. The results suggest that survival after severe trauma is not only a matter of short rescue time but more a matter of well-used rescue time including performance of vital measures already in the prehospital setting. This also includes that rescue teams identify the severity of injuries more rapidly in the most-severely injured patients in critical condition than in less-severely injured patients and plan their interventions accordingly.

Evaluation of the Berlin polytrauma definition: A Dutch nationwide observational study

“…On average, the total prehospital times are shorter in the Netherlands (55 minutes) than in Germany (68 minutes). 18 This time interval difference was smaller for patients with an ISS of ≥16, with 61 minutes for the Dutch group and 66 minutes for their German counterparts. 19 However, Timm et al 19 did not find clinically relevant differences in outcome parameters of severely injured patients that could be accounted for this 5-minute advantage in favor of the Dutch.…”

The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation

“…However, the study is limited by a small cohort size and a lack of analysis of the amount of interventions given [12]. Rapid transport to a trauma center is the optimal goal, but survival after severe trauma depends on not only short rescue time but also well-used rescue time [13]. For our case, expedient transportation of the victim was not possible, so judgment to intubate the patient was made based on his declining condition and the extended extrication time.…”

Prehospital time and mortality in polytrauma patients: a retrospective analysis

“…This is similar to Lerner et al, who, after adjustments for ISS > 15, patient demographics and treatment factors found no association between prehospital time and mortality [ 16 ]. In the prehospital phase, a well-used time frame is advocated by Klein et al in German and Austrian trauma systems, emphasizing the performance of lifesaving treatment on-scene [ 22 ]. In addition, in a recent study conducted by Mills et al, with a cohort of patients who were transported with the highest EMS priority after a traffic accident, also no association between prehospital time and mortality was found [ 13 ].…”