Longer Prehospital Time was not Associated with Mortality in Major Trauma: A Retrospective Cohort Study

Brown, Elizabeth; Tohira, Hideo; Bailey, Paul; Fatovich, Daniel M; Pereira, Gavin; Finn, Judith

doi:10.1080/10903127.2018.1551451

Cited by 21 publications

(16 citation statements)

References 26 publications

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“…Flowchart of included and excluded patients ≥16 years of age with major trauma, defined as an Injury Severity Score of >15 from a blunt, penetrating or thermal mechanism of injury and transported by St John Ambulance WA (SJA‐WA) in the Perth metropolitan area, WA either directly or indirectly to one of four hospitals who provided data to the WA State Trauma Registry between 1 January 2013 and 31 December 2016 …”

Section: Resultsmentioning

confidence: 99%

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

Brown

Tohira

Bailey

et al. 2019

Emerg Medicine Australasia

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Objective To describe the characteristics and outcomes of older adult (≥65 years) major trauma patients in comparison with younger adults (16–64 years). To determine whether older age is associated with a reduced likelihood of transport (directly or indirectly) to a major trauma centre and whether this is associated with in‐hospital mortality. Methods A retrospective cohort study of major trauma patients transported to hospital by St John Ambulance paramedics in Perth, Western Australia, between 1 January 2013 and 31 December 2016. Multivariate logistic regression was used to test the relationship between age and major trauma centre transport. Multivariate logistic regression analysis using inverse probability of treatment weighting was used to determine if major trauma centre transport was associated with in‐hospital mortality in older adults. Results One thousand six hundred and twenty‐five patients were included; of these 576 (35%) were ≥65 years. In comparison with younger adults, older adults had more falls as their mechanism of injury (n = 358 [62%] versus n = 102 [10%], P ≤ 0.001) and more major head injuries (n = 472 [82%] versus n = 609 [58%], P ≤ 0.001). Older adults had lower odds (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.35–0.78) of major trauma centre transport and this was associated with 1.7 times the likelihood of in‐hospital mortality (95% CI 1.04–2.7). Conclusions Older adults who were not transported to the trauma centre had an increased odds of in‐hospital mortality. However, older age was associated with a significantly reduced likelihood of trauma centre transport. With the aging population, the development of specific prehospital triage criteria to enable the complexities of this higher‐risk population to be identified is important.

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Section: Resultsmentioning

confidence: 99%

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

Brown

Tohira

Bailey

et al. 2019

Emerg Medicine Australasia

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“…The current study also reports that ACN is associated with shorter times to hospital arrival among less urban areas, though these times are still over the 30-minute threshold of increased mortality risk reported by Plevin et al (2017). Literature on the effect of transport time on trauma mortality reports are mixed, with studies out of Perth, Western Australia and South Korea reporting lower mortality for longer transport times and a study in Ghana reporting higher mortality among all-cause trauma (Brown et al 2019, Kim et al 2017, Mahama et al 2018. Despite this, research has reported that longer pre-hospital times are associated with an increased likelihood of more intensive interventions during the initial trauma resuscitation periods; as a result, it is possible that the effects of ACN availability of decreased pre-hospital times, particularly among rural areas, may result in decreased likelihood of escalation of care, resulting in more beneficial clinical outcomes such as shorter length of hospital stay and cost of care.…”

Section: Discussionmentioning

confidence: 48%

“…The concept of the "Golden Hour" is a time-honored and much-cited tenet of prehospital trauma care. In practice, there is a paucity of data to substantiate its validity, and there is no sudden change in the risk of death (Brown et al 2019). A recent study of more than 40,000 patients has shown that, in those with severe torso injuries, the risk of death increased with longer prehospital times, and was most prominent within the first 30 min (Alarhayem et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Automatic collision notification availability and emergency response times following vehicle collision—an analysis of the 2017 crash investigation sampling system

Griffin

Carroll

Jansen

2020

Traffic Injury Prevention

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Objective: To determine whether occupants of collisions involving at least one vehicle with an available Automatic Collision Notification (ACN) system have quicker times from collision to 1) Emergency Medical Services (EMS) notification and 2) arrival to a medical center. Methods: Using data from the 2017 Crash Investigation Sampling System, vehicles were categorized as whether ACN was available using data from the CISS's dataset of crash avoidance system availability (in which ACN is included though notably not a crash avoidance system). A Cox proportional hazards model-overall and stratified by urbanization-was used to compare the time from collision to both EMS notification and EMS arrival to a medical center. Results: A total of 2,034 collisions (weight n: 2,775,512) involving 4235 occupants (weighted n: 4,987,669) were included. An estimated 259,021 (9.3%) and 546,223 occupants (11.0%) were in a collision in which one vehicle had ACN equipped. The median time to EMS notification was longer for collisions in which no involved vehicles had ACN available (median 4, IQR 2-9 minutes) than ACN-exposed collisions (median 2, IQR 1-5 minutes). There was a marginally significant higher hazard (i.e., instantaneous risk) of EMS notification for collisions with at least one vehicle having ACN available (HR 1.77, 95% CI 0.99-3.15). Likewise, there was a higher instantaneous risk of medical center arrival for occupants (HR 1.80, 95% CI 1.41-2.30) involved in collisions in which at least one vehicle had ACN available. ACN was associated with quicker EMS notification only in urban areas (HR 3.06, 95% CI 1.57-5.97) and associated with a greater reduction in time to medical facility in less urban areas (median 36 vs 45 minutes, HR 2.12, 95% CI 1.22-3.63). Conclusions: This is the first study to directly compare EMS response-related times between collisions involving vehicles with and without ACN available. The current data corroborate prior literature reporting quicker EMS notification times among collisions involving ACN-equipped vehicles. This is the first study to find that ACN is also associated to quicker times to medical center arrival, particularly for collisions occurring in less urban areas. Future research examining whether these decreased times are associated with better clinical outcomes are needed in order to fully assess ACN's ability to prevent trauma-related mortality and morbidity.

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“…They also identified no difference in mortality outcomes when the rural trauma patient survived to admission to a tertiary trauma center, when compared to the urban trauma patient [52]. Bagher prehospital time "of one hour and 30-day mortality" (adjusted OR 1.1, 95% CI 0.71-1.69), but did find association between scene times and longer hospital lengths of stay, with each additional minute of on-scene time associated with 1.16 times longer length of hospital stay (95% CI 1.03-1.31) [36]. Finally, when total prehospital time was sub-divided into intervals (response time, scene time, and transport time), Brown et al found that there was an association (OR 1.21; 95% CI 1.02-1.44, p = 0.03) between prolonged scene time and mortality, regardless of transport modality (air or ground) [37].…”

Section: Prehospital Time As a Key Exposurementioning

confidence: 83%

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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Longer Prehospital Time was not Associated with Mortality in Major Trauma: A Retrospective Cohort Study

Cited by 21 publications

References 26 publications

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

Automatic collision notification availability and emergency response times following vehicle collision—an analysis of the 2017 crash investigation sampling system

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

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