The association between time intervals in emergency medical services and In-hospital mortality of trauma patients

Authors

1 Prehospital and Hospital Emergency Research Center; Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Emergency Medical Services, Iran Ministry of Health and Medical Education, Tehran, Iran

3 Tehran Emergency Medical Service Center, Tehran, Iran

4 Prehospital and Hospital Emergency Research Center; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

5 Prehospital and Hospital Emergency Research Center; Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Context: While the clinical practice recommends field stabilization in trauma patients, in some situations, the speed of transport is crucial. Aims: This study aimed to evaluate the association between emergency medical services (EMS) time intervals (response time [RT], scene time [ST], and transport time [TT]) and in-hospital mortality in trauma patients in Tehran, the largest metropolis of Iran. Settings and Design: A prospective cohort study was conducted between May 2017 and April 2018. Methods: All EMS operations related to trauma events in the Tehran city that were transferred to three targeted major trauma centers were included. Statistical Analysis: Logistic regression analysis was used to assess the relationship between EMS time intervals and other risk factors of trauma death. Results: A total of 14,372 trauma patients were included in the final analysis. In-hospital mortality occurred in 225 (1.6%) patients. After adjustment for confounding variables, older age (odds ratio [OR] = 1.04/year), female gender (OR = 2.16), low Mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure score (OR = 0.84 for each unit), low GCS (OR = 0.56 for each unit), longer ST (OR = 1.17/10 min), and longer TT (OR = 1.21/10 min) were found to be risk factors for death in trauma. Conclusions: Our study showed that in-hospital mortality of trauma patients correlated with longer EMS ST and TT, but the RT was not associated with mortality. Our results recommend that the EMS system should consider ST and TT rather than RT, as indexes of quality control in prehospital care of trauma patients.

Keywords

References

1. Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: Incidence, mortality, disability‑adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 2016;22:3‑18. 
2. Safari S, Radfar F, Baratloo A. Thoracic injury rule out criteria and NEXUS chest in predicting the risk of traumatic intra‑thoracic injuries: A diagnostic accuracy study. Injury 2018;49:959‑62. 
3. Haghparast‑BidgoliH, HasselbergM, KhankehH, Khorasani‑ZavarehD, Johansson E. Barriers and facilitators to provide effective pre‑hospital trauma care for road traffic injury victims in Iran: A grounded theory approach. BMC Emerg Med 2010;10:20. 
4. Rogers FB, Rittenhouse KJ, Gross BW. The golden hour in trauma: Dogma or medical folklore? Injury 2015;46:525‑7. 
5. Murray B, Kue R. The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: A comprehensive review of the literature – ADDENDUM. Prehosp Disaster Med 2019;34:345. 
6. Centers for Disease Control and Prevention (CDC). Ambulance crash‑related injuries among emergency medical services workers – United States, 1991‑2002. MMWR Morb Mortal Wkly Rep 2003;52:154‑6. 
7. Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, 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;55:235‑46. 
8. Kahn CA, Pirrallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: An 11‑year retrospective analysis. Prehosp Emerg Care 2001;5:261‑9. 
9. Mackersie RC. History of trauma field triage development and the American College of Surgeons criteria. Prehosp Emerg Care 2006;10:287‑94. 
10. 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;61:167‑74. 
11. Newgard CD, Meier EN, Bulger EM, Buick J, Sheehan K, Lin S, et al. Revisiting the “Golden Hour”: An evaluation of out‑of‑hospital time in shock and traumatic brain injury. Ann Emerg Med 2015;66:30‑41, 41.e1‑3. 
12. Smith RM, Conn AK. Prehospital care – Scoop and run or stay and play? Injury 2009;40 Suppl 4:S23‑6. 
13. Fleet R, Poitras J. Have we killed the golden hour of trauma? Ann Emerg Med 2011;57:73‑4. 
14. Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of prehospital mode of transport with mortality in penetrating trauma: A trauma system‑level assessment of private vehicle transportation vs. ground emergency medical services. JAMA Surg 2018;153:107‑13. 
15. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, Glasgow Coma Scale, age, and arterial pressure (MGAP): A new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 2010;38:831‑7. 
16. 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;44:606‑10. 
17. Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, et al. The OPALS major trauma study: Impact of advanced life‑support on survival and morbidity. CMAJ 2008;178:1141‑52. 
18. Osterwalder JJ. Can the “golden hour of shock” safely be extended in blunt polytrauma patients? Prospective cohort study at a level I hospital in eastern Switzerland. Prehosp Disaster Med 2002;17:75‑80. 
19. Möller A, Hunter L, Kurland L, Lahri S, van Hoving DJ. The association between hospital arrival time, transport method, prehospital time intervals, and in‑hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town. Afr J Emerg Med 2018;8:89‑94. 
20. Bulger EM, May S, Brasel KJ, Schreiber M, Kerby JD, Tisherman SA, et al. Out‑of‑hospital hypertonic resuscitation following severe traumatic brain injury: A randomized controlled trial. JAMA 2010;304:1455‑64. 
21. Brasel KJ, BulgerE, CookAJ, MorrisonLJ, NewgardCD, Tisherman SA, et al. Hypertonic resuscitation: Design and implementation of a prehospital intervention trial. J Am Coll Surg 2008;206:220‑32. 
22. Newgard CD, Rudser K, HedgesJR, Kerby JD, Stiell IG, Davis DP, et al. A critical assessment of the out‑of‑hospital trauma triage guidelines for physiologic abnormality. J Trauma 2010;68:452‑62. 
23. 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. J Emerg Trauma Shock 2013;6:16‑20. 
24. Wilde ET. Do emergency medical system response times matter for health outcomes? Health Econ 2013;22:790‑806. 
25. McConnell KJ, Newgard CD, Mullins RJ, Arthur M, Hedges JR. Mortality benefit of transfer to level I versus level II trauma centers for head‑injured patients. Health Serv Res 2005;40:435‑57. 

Files

History

  • Receive Date: 09 November 2020
  • Accept Date: 09 November 2020

Share

How to cite

Statistics