Abstract
IntroductionSevere blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality.ResultsAmong 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results.ConclusionsThis study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.
Highlights
Severe blunt trauma is a leading cause of premature death and handicap
SMUR patients were less frequently admitted to the first hospital within the first hour, and more frequently to an intensive care units (ICU) within the first three hours after the accident
The lower rate of tracheal intubation, ventilation, and vasopressor administration in patients rapidly admitted to hospital strongly suggests that emergency physician (EP) involvement in starting resuscitation care early before hospital admission could be beneficial for patients with severe blunt trauma, as reported in other studies [33,34,35]. This observational study suggests that, despite delayed hospital admission, SMUR management was associated with lower 30-day mortality after blunt trauma
Summary
Severe blunt trauma is a leading cause of premature death and handicap. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d’Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. According to the World Health Organization, injuries are the leading cause of death for people under the age of 45. The prevention and management of severe trauma are major public health issues in most countries. In contrast to trauma epidemiology in the United States, blunt trauma is more frequent than penetrating trauma in most European countries, and the leading cause of severe trauma. Medical pre-hospital management (SMUR: Service Mobile d’Urgences et de Réanimation), generally performed by an emergency physician (EP), may take longer than care provided by fire brigades. The benefit for blunt trauma victims of SMUR management on the scene of the accident is controversial [4]
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