The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma☆
Received 24 May 2009; received in revised form 15 December 2009; accepted 20 December 2009. published online 18 January 2010.
Abstract
Aim
The benefit of a well organised trauma system is acknowledged but doubts remain concerning the optimal pre-hospital trauma care model. We hypothesise that the treatment of life-threatening events before arrival at trauma centre – either pre-hospital or first hospital – may be more relevant to decreasing mortality than shortening the time to trauma centre.
Methods
A cohort of 727 trauma patients with life-threatening events – identified as airway, breathing, circulation or neurological disability – requiring transfer to a trauma centre were studied. Data on patient's characteristics, trauma features, and mortality were taken from a trauma registry. Patients were divided into 3 groups depending on the place of treatment of life-threatening events: pre-hospital, first hospital or trauma centre. Survival Kaplan–Meier curves and logistic regression were used to assess the effect of place of treatment of life-threatening events on mortality.
Results
Patients from the pre-hospital and first hospital groups had 20% and 27% mortality respectively, compared to 38% among those whose life-threatening events were corrected only at the trauma centre. Logistic regression showed that patients whose life-threatening events were corrected only at the trauma centre had an odds of death 3.3 times greater than those from the pre-hospital group, adjusted for patient and trauma characteristics and time to trauma centre.
Conclusion
In trauma patients requiring transfer to a trauma centre, pre-hospital interventions to treat life-threatening events may significantly decrease mortality when compared to similar interventions performed later at the trauma centre.
aUnidade de Cuidados Intensivos Polivalente, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001 Porto, Portugal
bServiço de Bioestatística e Informática Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
cCINTESIS (Centro de Investigação em Tecnologias da Saúde e Sistemas de Informação em Saúde), Serviço de Bioestatística e Informática Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
dTrauma Audit and Research Network, University of Manchester, Manchester Academic Health Sciences Centre, Hope Hospital, Salford M6 8HD, United Kingdom
ABSTRACT