Weather and prehospital predictors of trauma patient mortality in a rural American state

Abstract

In rural settings, factors like weather and location can significantly impact total prehospital time and survival after injury. We sought to determine what prehospital conditions affect mortality and morbidity in severely injured patients. We retrospectively evaluated adult trauma patients that were admitted to our level 1 trauma center with Glasgow Coma Score (GCS≤ 9), hypotension (SBP≤ 90 mmHg), or both. Weather and prehospital conditions on patient outcomes were evaluated. Weather data was extracted from the National Oceanographic and Atmospheric Administration public database. Prediction models were done using bivariate and multivariate logistic regression analysis. A total of 442 subjects were captured, Median time on the scene was 15 min [IQR =10, 20.5], with median time to definitive care 129 min [IQR= 61, 247]. Hypotension in the field was the greatest predictor of ED mortality (OR=11, P = 0.004), and field hypoxia (OR=3, P = 0.007) was a predictor of in-hospital mortality. Patients with field GCS ≤ 9 had higher odds of ICU admission (OR=2, P = 0.029). Among transfers, increasing prehospital time correlated with ED mortality while injury during warmer weather showed lower odds (OR =0.94, P = 0.019) of mortality. No weather condition predicted mortality for patients that presented directly from the field. Among severely injured patients being injured during cold weather was associated with higher in-hospital mortality among trauma transfer patients. Prehospital hypotension, hypoxia, and GCS≤9 are also independent predictors of mortality. Future analysis will explore factors impacting transport and field time in order to improve outcomes.