The impact of injury severity and prehospital procedures on scene time in victims of major trauma

Spaite, Daniel W.; Tse, David J; Valenzuela, Terence D.; Criss, Elizabeth A.; Meislin, Harvey W.; Mahoney, Mark; Ross, J. G.

doi:10.1016/s0196-0644(05)81070-4

Cited by 91 publications

(42 citation statements)

References 78 publications

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“…8,9 In addition, there are concerns that the on-scene time spent providing advanced life-support measures may ac-tually delay life-saving expeditious transfer to the hospital and the operating room. 10 To date, no large controlled clinical trials have been conducted to evaluate the impact of prehospital advanced life-support programs on trauma-related mortality and morbidity. 3 As part of the Ontario Prehospital Advanced Life Support (OPALS) studies, we recently demonstrated that advanced life-support programs had no impact on the outcomes of patients who had experienced cardiac arrest, but they did lead to significant improvement in survival among patients with respiratory distress.…”

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confidence: 99%

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

Stiell¹

2005

Academic Emergency Medicine

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Background:To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established Methods:The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results:Among the 2867 patients enrolled in the basic lifesupport (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16). Interpretation:The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced lifesupport phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.

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confidence: 99%

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

Stiell¹

2005

Academic Emergency Medicine

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“…During the study period, 15 One-way ANOVA and post-hoc analysis using Tukey's honestly significant difference tests revealed significant differences in ER stay times between TAE and ORIF (p<0.001) and laparotomy and ORIF (p<0.05). p<0.001).…”

Section: Resultsmentioning

confidence: 97%

“…This study showed prehospital times of 48.2±23.6 min, while a US meta-analysis of trauma patients [14] showed prehospital times of 43.17 min in rural areas, 30.97 min suburban areas, and 30.96 min in urban areas. Several studies [15][16][17][18] found that a decrease in prehospital time resulted in improved patient survival. Medical administrative approaches are needed to expand the trauma transportation system in Japan and reduce prehospital time.…”

Section: Delay In Prehospital Phasementioning

confidence: 99%

Is preoperative period associated with severity and unexpected death of injured patients needing emergency trauma surgery?

et al. 2013

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PurposeEarly operative control of hemorrhage is the key to saving the lives of severe trauma patients. We investigated whether emergency room (ER) stay time (time from the ER to the operating room [OR]) is associated with trauma severity and unexpected trauma death (Trauma and Injury Severity Score [TRISS] method-based Probability of survival [Ps] ≥0.5 but died) of injured patients needing emergency trauma surgery. MethodsWe performed a retrospective review of call trauma patients requiring emergency surgery and all patients with pelvic fractures requiring transcatheter arterial embolization at our hospital from ConclusionsOur results suggest that every medical staff should work together effectively on high-risk patients in the ER, bringing them immediately to the OR according to their level of risk. If injured patients need emergency trauma surgery, ER stay times should be kept as short as possible to reduce unexpected trauma death.

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“…Trabalhos internacionais apresentam tempos médios de cena entre de 13,9 a 21min, sendo os tempos maiores, alcançados em vítimas mais graves. 1,10,14 Os valores médios de tempo consumido até o hospital, principalmente, nos quadros de RTS≤10, são maiores que o alcançado pelo estudo de Roorda et al, 10 que demonstrou faixa entre 8 e 9,8 min. O deslocamento das equipes em busca de hospitais terciários pode explicar o maior tempo consumido em transporte para essas vítimas quando comparados às que apresentaram RTS=11 ou 12.…”

Section: Resultsunclassified

“…2,7 Mudanças ou flutuações na pontuação inicial do índice sugerem melhora, piora, ou manutenção do quadro clínico. 1,4,7,9,14 Observou-se a piora do índice em apenas duas víti-mas de RTS=12. Apesar de pouco expressivo percentualmente, este dado representa um alerta às Considerando que um dos propósitos do APH é a busca pela estabilização, impedindo a piora do quadro até a chegada ao hospital, 99,7% das vítimas com RTS=12 se mantiveram no índice inicial até o hospital de destino.…”

Section: Discussionunclassified

Suporte avançado à vida: atendimento a vítimas de acidentes de trânsito

Malvestio

Sousa

2002

Rev. Saúde Pública

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The impact of injury severity and prehospital procedures on scene time in victims of major trauma

Cited by 91 publications

References 78 publications

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

OPALS Major Trauma Study: Impact of Advanced Life Support on Survival and Morbidity

Is preoperative period associated with severity and unexpected death of injured patients needing emergency trauma surgery?

Suporte avançado à vida: atendimento a vítimas de acidentes de trânsito

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