Abstract
Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.
Highlights
Traumatic injury is a leading cause of death and disability, among young people, and involves a substantial economic burden for society [1, 2]
We excluded 627 patients who were transported from other facilities and 264 patients who were transported by a helicopter emergency medical service
Using one-to-one propensity scores (PS) matching, we selected 295 pairs of patients who were transported by emergency physician (EP)-staffed ambulance or by emergency life-saving technicians (ELST)-staffed ambulance
Summary
Traumatic injury is a leading cause of death and disability, among young people, and involves a substantial economic burden for society [1, 2]. According to the World Health Organization, more than 5 million people die annually as a result of injuries, which accounts for 9% of the world’s deaths [3]. Previous studies have shown that rapid patient transfer to a trauma center and rapid initiation of definitive care, such as surgery or transarterial embolization (TAE), strongly influence survival among severely injured patients [4,5,6,7,8,9]. The preoperative time course, such as prehospital length of stay (LOS), emergency department (ED) LOS, and total time to surgery or TAE, is regarded as an important parameter in trauma care [10, 11]
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