Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

Abstract

Introduction Severe 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. Methods The 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. Results Among 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. Conclusions This 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.

Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center

“…Thus, the relationship between the early risk of tension PTXs or OPTXs and the positive pressure ventilation is still under debate. The French prehospital system of care (the SAMU system) has been well described in the literature [31,32]. The specific indicators for instituting prehospital mechanical ventilation in patients with severe trauma are based on respiratory, hemodynamic, neurologic, and analgesia parameters.…”

Traumatisme thoracique : prise en charge des 48 premières heures

“…Dans le cadre d'un traumatisme grave, la tomodensitométrie thoracique s'intègre dans la réalisation d'une tomodensitométrie corps entier, cet examen ayant montré une réduction relative de la mortalité intrahospitalière observée de 25 % (IC 95 ) par rapport à la mortalité prédite par le score TRISS (Trauma and Injury Severity Score) et de 13 % (IC 95 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]) par le score RISC (Revised Injury Severity Classification) [14]. Chez les patients stables sans critères de gravité, l'échographie pleuropulmonaire permet le diagnostic des fractures sternales ou costales suspectées ignorées par la radiographie de thorax.…”

“…Thoracotomie de ressuscitation [3,[3][4][5]5]) en cas de plaie par arme à feu. Parmi l'ensemble des blessures du tronc, celles qui étaient à prédominance cardiaque étaient associées à la survie la plus élevée 19,4 % (IC 95 [17,8]) vs 10,7 % (IC 95 [9,[1][2][3][4][5][6][7][8][9][10][11][12]3]) en cas de plaie thoracique. On note également qu'en présence de SDV à l'admission, la survie est de 11,5 % (IC 95 [9,[6][7][8][9][10][11][12][13]4]) vs 2,6 % (IC 95 [1,8] [98,).…”

Comparative Hemodynamic Evaluation of the LUCAS® Device and Manual Chest Compression in Patients with Out-of-Hospital Cardiac Arrest

“…The cardio-pulmonary resuscitation could be performed by a ire brigade in the irst time and in a second time by pre-hospital medical emergency team (SMUR= Service Mobile d'Urgence et de Réanimation). The French SAMU/SMUR system is well described in the literature [9,10] (SAMU= Service d'Aide Médicale Urgente). Each patient was his/her own control.…”