Influence of prehospital response times in the survival of trauma patients in Navarre
DOI:
https://doi.org/10.23938/S1137-6627/2016000100021Keywords:
Polytrauma mortality. “Golden hour”. Prehospital response times.Abstract
The relation between response times and mortality of polytrauma patients in the so-called “golden hour” continues to be a subject of debate.
The purpose of this study is to determine the variables related to mortality in these patients and the influence of response times of the Emergency Medical Services in this mortality.
To this end, the data in the “Major Trauma ofNavarre” Register (retrospective cohort of polytrauma patients attended to by the Navarre Health Service) were analyzed for the four year period between 2010 and 2013.
Of the 217 trauma cases available for the analysis, 42 (19 %) died. No significant association was found in the multivariate analysis between the different response times and mortality: arrival at the scene (odds ratio (OR) 1.0; 95% confidence interval (CI) from 0.99 to 1.01), in the scenario (OR 1.00; 95% CI from 0.98 to 1.02) and total time (OR 1.00; 95% CI from 0.99 to 1.01). The variables that influenced mortality are patient age and severity of injuries measured by the prehospital Triage-Revised Trauma Score (T-RTS) and the New Injury Severity Score (NISS).
The mortality of polytrauma patients attended to by the emergency system in our region is influenced by age and by the intensity of the aggression suffered, determined by the prehospital T-RTS and by the NISS. The response times of the hospital do not have a significant influence.Downloads
References
1. Tissier C, Bonithon-Kopp C, Freysz M, French Intensive care Recorded in Severe Trauma (FIRST) study group. Statement of severe trauma management in France; teachings of the FIRST study. Ann Fr Anesth Reanim 2013; 32: 465-471.
https://doi.org/10.1016/j.annfar.2013.07.003
2. McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban level I trauma center. Ann Emerg Med 2013; 61: 167-174.
https://doi.org/10.1016/j.annemergmed.2012.08.026
3. Bartolacci RA, Munford BJ, Lee A, McDougall PA. Air medical scene response to blunt trauma: Effect on early survival. Med J Aust. 1998; 169: 612-616.
https://doi.org/10.5694/j.1326-5377.1998.tb123435.x
4. Dinh MM, Bein K, Roncal S, Byrne CM, Petchell J, Brennan J. Redefining the golden hour for severe head injury in an urban setting: The effect of prehospital arrival times on patient outcomes. Injury. 2013; 44: 606-610.
https://doi.org/10.1016/j.injury.2012.01.011
5. Feero S, Hedges JR, Simmons E, Irwin L. Does out-of-hospital ems time affect trauma survival. Am J Emerg Med. 1995; 13: 133-135.
https://doi.org/10.1016/0735-6757(95)90078-0
6. Lerner EB, Moscati RM. The golden hour: Scientific fact or medical "urban legend"? Acad Emerg Med. 2001; 8: 758-760.
https://doi.org/10.1111/j.1553-2712.2001.tb00201.x
7. Belzunegui T, Fortun M, Reyero D, Teijeira R. Implementation of the first spanish population- based register of multiple injury cases in Navarre. Emerg. 2013; 25: 196-200.
8. Dick WF, Baskett PJ, Grande C, et al. Recommendations for uniform reporting of data following major trauma--the utstein style. an international trauma anaesthesia and critical care society (ITACCS) initiative. Br J Anaesth. 2000; 84: 818-819.
https://doi.org/10.1093/oxfordjournals.bja.a013601
9. Belzunegui T, Gradin C, Fortun M, Cabodevilla A, Barbachano A, Antonio Sanz J. Major trauma registry of Navarre (Spain)/ The accuracy of different survival prediction models. Am J Emerg Med. 2013; 31: 1382-1388.
https://doi.org/10.1016/j.ajem.2013.06.026
10. Prat S, Dominguez-Sampedro P, Koo M, Colilles C, Jimenez-Fabrega X, Espinosa L. TraumCat/ Preliminary analysis of a year of severe trauma registry in Catalonia. Emerg. 2014; 26: 267-274.
11. Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization/ A process-outcome evaluation. J Trauma. 1999; 46: 565-579.
https://doi.org/10.1097/00005373-199904000-00004
12. Wyen H, Lefering R, Maegele M, et al. The golden hour of shock - how time is running out/ Prehospital time intervals in Germany--a multivariate analysis of 15, 103 patients from the TraumaRegister DGU(R). Emerg Med J. 2013; 30: 1048-1055.
https://doi.org/10.1136/emermed-2012-201962
13. Carr BG, Caplan JM, Pryor JP, Branas CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006; 10: 198-206.
https://doi.org/10.1080/10903120500541324
14. Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma/ Assessment of the "golden hour" in a north american prospective cohort. Ann Emerg Med. 2010; 55: 235-246.
https://doi.org/10.1016/j.annemergmed.2009.07.024
15. Sampalis JS, Lavoie A, Williams JI, Mulder DS, Kalina M. Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma. 1993; 34: 252-261.
https://doi.org/10.1097/00005373-199302000-00014
16. Swaroop M, Straus DC, Agubuzu O, Esposito TJ, Schermer CR, Crandall ML. Pre-hospital transport times and survival for hypotensive patients with penetrating thoracic trauma. Journal of emergencies, trauma, and shock. 2013; 6: 16-20.
https://doi.org/10.4103/0974-2700.106320
17. Gomez de Segura Nieva JL, Boncompte MM, Sucunza AE, Louis CL, Segui-Gomez M, Otano TB. Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care/ Atlantic pyrenees (France) and Navarra (Spain). J Emerg Med. 2009; 37: 189-200.
https://doi.org/10.1016/j.jemermed.2007.10.089
18. Yeguiayan JM, Garrigue D, Binquet C, et al. Medical pre-hospital management reduces mortality in severe blunt trauma/ A prospective epidemiological study. Crit Care. 2011; 15: R34.
https://doi.org/10.1186/cc9982
19. Paravar M, Hosseinpour M, Mohammadzadeh M, Mirzadeh AS. Prehospital care and in-hospital mortality of trauma patients in iran. Prehosp Disaster Med. 2014; 29: 473-477.
https://doi.org/10.1017/S1049023X14000879
20. Di Bartolomeo S, Valent F, Rosolen V, et al. Are pre-hospital time and emergency department disposition time useful process indicators for trauma care in italy? Injury. 2007; 38: 305-311.
https://doi.org/10.1016/j.injury.2006.10.005
21. Ivatury RR, Nallathambi MN, Roberge RJ, Rohman M, Stahl W. Penetrating thoracic injuries/ In-field stabilization vs. prompt transport. J Trauma. 1987; 27: 1066-1073.
https://doi.org/10.1097/00005373-198709000-00019
22. Grossman DC, Kim A, Macdonald SC, Klein P, Copass MK, Maier RV. Urban-rural differences in prehospital care of major trauma. J Trauma. 1997; 42: 723-729.
https://doi.org/10.1097/00005373-199704000-00024
23. Ryynanen OP, Iirola T, Reitala J, Palve H, Malmivaara A. Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med. 2010; 18: 18-62.
https://doi.org/10.1186/1757-7241-18-62
24. Fleet R, Poitras J. Have we killed the golden hour of trauma? Ann Emerg Med. 2011; 57: 73-74.
https://doi.org/10.1016/j.annemergmed.2010.08.003
25. Barrett TW, Brywczynski JJ, Schriger DL. Journal club/ Is the golden hour tarnished? registries and multivariable regression. Ann Emerg Med. 2010; 55: 247-248.
https://doi.org/10.1016/j.annemergmed.2010.01.001
26. Little WK. Golden hour or golden opportunity/ Early management of pediatric trauma. Clinical Pediatric Emergency Medicine. 2010; 11: 4-9.
https://doi.org/10.1016/j.cpem.2009.12.005
27. Alberdi F, Azaldegui F, Zabarte M, et al. Epidemiological profile of late mortality in severe polytraumatisms. Med Intensiva. 2013; 37: 383-390.
Published
How to Cite
Issue
Section
License
Copyright (c) 2015 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
