Abstract
BackgroundThe time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center.MethodsA retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality.ResultsIn total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156).ConclusionThis analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.
Highlights
The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma
In the Netherlands, additional to the care provided by EMS, assistance from physician staffed Helicopter Emergency Medical Services (HEMS) can be requested to provide advanced specialized care and interventions onscene, such as tracheal intubation, administration of advanced analgesia, chest tube placement and surgical procedures
A previous systematic analysis has shown that for patients suffering penetrating or traumatic brain injury, a brief prehospital time would decrease mortality rates. This is in contrast with undifferentiated hemodynamically stable patients, who showed no increase in mortality odds with increasing prehospital time [5]
Summary
The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Berkeveld et al BMC Emergency Medicine (2021) 21:78 injured patients and rapidly transport them to an appropriate trauma center Despite these available methods, the optimal duration of prehospital time for severely injured patients is difficult to determine, as there is an assumption that a broad variety of factors could influence the prehospital time and mortality risk [4]. A previous systematic analysis has shown that for patients suffering penetrating or traumatic brain injury, a brief prehospital time would decrease mortality rates. This is in contrast with undifferentiated hemodynamically stable patients, who showed no increase in mortality odds with increasing prehospital time [5].
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