Efficacy of the presence of an emergency physician in prehospital major trauma care: A nationwide cohort study in Japan

Hirano, Yohei; Abe, Toshikazu; Tanaka, Hiroshi

doi:10.1016/j.ajem.2018.11.014

Cited by 24 publications

(43 citation statements)

References 21 publications

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“…However, the analysis discovered that there was a significant increase in the number of prehospital procedures performed without a significant difference in prehospital time. Bieler et al's findings were also supported by a Japan study [20].…”

Section: Discussionmentioning

confidence: 66%

“…While many of these studies were unable to associate ECTs with reduced mortality, one reason for this perceived lack of benefit is that ECTs are generally deployed to more severe cases with victims often presenting with a higher ISS or in a more unstable condition [20]. Each trauma case is unique, and an experienced incident commander should be able to discern whether an ECT is appropriate, especially when resources are limited.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation

Chiapuzio

Dang

Meagher

et al. 2020

Cureus

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Trauma is the leading cause of morbidity and mortality for those under 45 years of age in the United States with half of the deaths in trauma being attributed to hemorrhagic shock. The use of enhanced care teams (ECTs) that include physicians in selective prehospital settings has allowed the delivery of advanced critical care interventions in the field. We present a unique case where a young driver involved in a motor vehicle accident was trapped under the weight of his vehicle, causing extended extrication time. An ECT from the closest trauma center was able to deliver massive transfusion and definitive airway care while the patient was being extricated. While previous literature regarding the benefit of ECTs has been debated, this case suggests a unique niche where rapid deployment of an ECT to the scene made a pronounced difference in survival of the patient.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation

Chiapuzio

Dang

Meagher

et al. 2020

Cureus

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“…Physician-led prehospital management is potentially beneficial in severe trauma patients since physicians are generally allowed to provide broad scope of medical interventions than paramedics. Some previous randomized controlled trials [ 1 , 2 ] and cohort studies [ 3 – 5 ] suggested beneficial effects of physician-led prehospital trauma management. However, a recent systematic review concluded that evidence supporting the effectiveness of physician-led prehospital management was insufficient because of the limited number of studies with high methodological quality [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: a retrospective analysis of the Japanese nationwide trauma registry

Endo

Kojima

Uchiyama

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. Methods This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. Results A total of 30,551 patients (physician-led: 2976, paramedic-led: 27,575) were eligible for analysis, of whom 2690 propensity score-matched pairs (physician-led: 2690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age < 65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time < 60 min were likely to benefit from physician-led prehospital management. Conclusions Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

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“…However, the effect of physician-led over paramedic-led prehospital management in severe trauma patients has been debatable. Although some randomized controlled trials [1,2] and cohort studies [3][4][5] suggested bene cial effects of physician-led prehospital trauma management, a recent systematic review concluded that evidence of the superiority of physician-led over paramedic-led prehospital management in severe trauma patients is insu cient because of the limited number of studies with high methodological quality. [6] Notably, some studies evaluating this topic included helicopter emergency medical service (HEMS) with physicians, which had two major advantages: prehospital physician-led management itself and the shortened prehospital transport time.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Physician-Led Prehospital Management in Severe Trauma Patients: A Retrospective Analysis of the Japanese Nationwide Trauma Registry

Endo¹,

Kojima²,

Uchiyama³

et al. 2020

Preprint

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Background: The comparative effectiveness of physician-led over paramedic-led prehospital trauma management has been inconclusive. Regarding this topic, in some previous studies, the impacts of physician-led prehospital management were affected by the advantage of shortened prehospital time by helicopter transportation. This study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time.Methods: This retrospective cohort study analyzed the data of severe trauma patients who were transported directly to a hospital during 2009–2018 using Japan’s nationwide trauma registry. In-hospital mortality was compared between patients who received physician-led prehospital management and those who received paramedic-led management, using 1:4 propensity score-matched analysis. The propensity score was calculated using information on patient demographics, mechanism of injury, and vital signs at the scene of injury, as well as prehospital transport time. Subgroup analysis was performed to identify patients who were most likely to benefit from physician-led prehospital management.Results: A total of 30,968 patients (physician-led: 3,032, paramedic-led: 27,936) were eligible for analysis, of whom 2,766 propensity score-matched pairs (i.e., physician-led: 2766, paramedic-led: 11,064) were generated and compared. Physician-led pre-hospital trauma management showed significant superiority over paramedic-led prehospital trauma management (in-hospital mortality: 395 [14.3%] and 1785 [16.1%], respectively; odds ratio [95% confidence interval] = 0.87 [0.77–0.97], p = 0.017). In subgroup analysis, cases characterized by patient age <65 years, Injury Severity Score ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and prehospital transport time <60 min likely benefitted from physician-led prehospital management.Conclusions: The result of a largescale registry-based cohort study showed that physician-led prehospital trauma management was significantly associated with survival benefit independent of prehospital transport time. The findings may provide a basis for future research to assess effective physician-provided treatments in prehospital-field.

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Efficacy of the presence of an emergency physician in prehospital major trauma care: A nationwide cohort study in Japan

Cited by 24 publications

References 21 publications

The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation

The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation

Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: a retrospective analysis of the Japanese nationwide trauma registry

Effectiveness of Physician-Led Prehospital Management in Severe Trauma Patients: A Retrospective Analysis of the Japanese Nationwide Trauma Registry

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