A comparison of prehospital and hospital data in trauma patients

Saman Arbabi, Gregory Jurkovich, Wendy L. Wahl, Glen A. Franklin, Mark R. Hemmila, Paul A. Taheri, Ronald V. Maier

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Objective: The use of prehospital data as an indicator for trauma team activation has been established. The relationship between field (Fd) and emergency department (ED) systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, and airway control as it relates to outcomes is unclear. We hypothesized that ED and Fd physiologic parameters are equally valid predictors of outcomes. In addition, we hypothesized that early field intubation will improve survival compared with later ED intubation. Methods: Trauma registry data from two academic Level I centers from 1994 to 2001, excluding all transfers and burn patients, were analyzed using Wilcoxon signed-rank test and multivariate logistic regression with appropriate adjustments. Results: There were 19,409 patients, 16,277 blunt and 3,132 penetrating trauma. There were 3,571 Fd and 746 ED intubations. ED intubation was associated with increased risk of fatal outcome compared with nonintubated patient (adjusted odds ratio, 3.1; p < 0.0001) and field intubations (adjusted odds ratio, 3.0; p < 0.0001). ED-GCS score was not significantly different from Fd-GCS score, with 82% having the same GCS category. This was not the case for SBP, and only in 60% of the cases were ED-SBP and Fd-SBP in the same category. In 31% of the patients, the ED-SBP increased, and in 9% of cases, the ED-SBP decreased compared with Fd-SBP. This was true for both blunt and penetrating trauma. Both Fd-SBP and ED-SBP were independent predicators of fatal outcome, and mortality rate significantly increased if ED-SBP category decreased compared with Fd-SBP. Conclusion: Early field intubation was associated with a decreased risk of fatal outcome compared with ED intubation. ED-GCS score was not significantly different from Fd-GCS score, and either one can be used to predict fatal outcome. However, ED-SBP was different from Fd-SBP in 40% of the patients, with the majority of cases having higher ED-SBP. Although ED-SBP was a better predictor of outcome, the best model is achieved when both ED and field SBP are used.

Original languageEnglish (US)
Pages (from-to)1029-1032
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume56
Issue number5
DOIs
StatePublished - Jan 1 2004
Externally publishedYes

Fingerprint

Blood Pressure
Wounds and Injuries
Hospital Emergency Service
Glasgow Coma Scale
Intubation
Fatal Outcome
Odds Ratio
Patient Transfer
Airway Management

Keywords

  • Blood pressure
  • Blunt
  • Emergency department
  • Field
  • Glasgow Coma Scale score
  • Hypotension
  • Intubation
  • Mortality
  • Outcomes
  • Penetrating
  • Prehospital
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A comparison of prehospital and hospital data in trauma patients. / Arbabi, Saman; Jurkovich, Gregory; Wahl, Wendy L.; Franklin, Glen A.; Hemmila, Mark R.; Taheri, Paul A.; Maier, Ronald V.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 56, No. 5, 01.01.2004, p. 1029-1032.

Research output: Contribution to journalArticle

Arbabi, Saman ; Jurkovich, Gregory ; Wahl, Wendy L. ; Franklin, Glen A. ; Hemmila, Mark R. ; Taheri, Paul A. ; Maier, Ronald V. / A comparison of prehospital and hospital data in trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 56, No. 5. pp. 1029-1032.
@article{4fccef87ef21443d9aedc517d41ab82f,
title = "A comparison of prehospital and hospital data in trauma patients",
abstract = "Objective: The use of prehospital data as an indicator for trauma team activation has been established. The relationship between field (Fd) and emergency department (ED) systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, and airway control as it relates to outcomes is unclear. We hypothesized that ED and Fd physiologic parameters are equally valid predictors of outcomes. In addition, we hypothesized that early field intubation will improve survival compared with later ED intubation. Methods: Trauma registry data from two academic Level I centers from 1994 to 2001, excluding all transfers and burn patients, were analyzed using Wilcoxon signed-rank test and multivariate logistic regression with appropriate adjustments. Results: There were 19,409 patients, 16,277 blunt and 3,132 penetrating trauma. There were 3,571 Fd and 746 ED intubations. ED intubation was associated with increased risk of fatal outcome compared with nonintubated patient (adjusted odds ratio, 3.1; p < 0.0001) and field intubations (adjusted odds ratio, 3.0; p < 0.0001). ED-GCS score was not significantly different from Fd-GCS score, with 82{\%} having the same GCS category. This was not the case for SBP, and only in 60{\%} of the cases were ED-SBP and Fd-SBP in the same category. In 31{\%} of the patients, the ED-SBP increased, and in 9{\%} of cases, the ED-SBP decreased compared with Fd-SBP. This was true for both blunt and penetrating trauma. Both Fd-SBP and ED-SBP were independent predicators of fatal outcome, and mortality rate significantly increased if ED-SBP category decreased compared with Fd-SBP. Conclusion: Early field intubation was associated with a decreased risk of fatal outcome compared with ED intubation. ED-GCS score was not significantly different from Fd-GCS score, and either one can be used to predict fatal outcome. However, ED-SBP was different from Fd-SBP in 40{\%} of the patients, with the majority of cases having higher ED-SBP. Although ED-SBP was a better predictor of outcome, the best model is achieved when both ED and field SBP are used.",
keywords = "Blood pressure, Blunt, Emergency department, Field, Glasgow Coma Scale score, Hypotension, Intubation, Mortality, Outcomes, Penetrating, Prehospital, Trauma",
author = "Saman Arbabi and Gregory Jurkovich and Wahl, {Wendy L.} and Franklin, {Glen A.} and Hemmila, {Mark R.} and Taheri, {Paul A.} and Maier, {Ronald V.}",
year = "2004",
month = "1",
day = "1",
doi = "10.1097/01.TA.0000123036.20919.4B",
language = "English (US)",
volume = "56",
pages = "1029--1032",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - A comparison of prehospital and hospital data in trauma patients

AU - Arbabi, Saman

AU - Jurkovich, Gregory

AU - Wahl, Wendy L.

AU - Franklin, Glen A.

AU - Hemmila, Mark R.

AU - Taheri, Paul A.

AU - Maier, Ronald V.

PY - 2004/1/1

Y1 - 2004/1/1

N2 - Objective: The use of prehospital data as an indicator for trauma team activation has been established. The relationship between field (Fd) and emergency department (ED) systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, and airway control as it relates to outcomes is unclear. We hypothesized that ED and Fd physiologic parameters are equally valid predictors of outcomes. In addition, we hypothesized that early field intubation will improve survival compared with later ED intubation. Methods: Trauma registry data from two academic Level I centers from 1994 to 2001, excluding all transfers and burn patients, were analyzed using Wilcoxon signed-rank test and multivariate logistic regression with appropriate adjustments. Results: There were 19,409 patients, 16,277 blunt and 3,132 penetrating trauma. There were 3,571 Fd and 746 ED intubations. ED intubation was associated with increased risk of fatal outcome compared with nonintubated patient (adjusted odds ratio, 3.1; p < 0.0001) and field intubations (adjusted odds ratio, 3.0; p < 0.0001). ED-GCS score was not significantly different from Fd-GCS score, with 82% having the same GCS category. This was not the case for SBP, and only in 60% of the cases were ED-SBP and Fd-SBP in the same category. In 31% of the patients, the ED-SBP increased, and in 9% of cases, the ED-SBP decreased compared with Fd-SBP. This was true for both blunt and penetrating trauma. Both Fd-SBP and ED-SBP were independent predicators of fatal outcome, and mortality rate significantly increased if ED-SBP category decreased compared with Fd-SBP. Conclusion: Early field intubation was associated with a decreased risk of fatal outcome compared with ED intubation. ED-GCS score was not significantly different from Fd-GCS score, and either one can be used to predict fatal outcome. However, ED-SBP was different from Fd-SBP in 40% of the patients, with the majority of cases having higher ED-SBP. Although ED-SBP was a better predictor of outcome, the best model is achieved when both ED and field SBP are used.

AB - Objective: The use of prehospital data as an indicator for trauma team activation has been established. The relationship between field (Fd) and emergency department (ED) systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, and airway control as it relates to outcomes is unclear. We hypothesized that ED and Fd physiologic parameters are equally valid predictors of outcomes. In addition, we hypothesized that early field intubation will improve survival compared with later ED intubation. Methods: Trauma registry data from two academic Level I centers from 1994 to 2001, excluding all transfers and burn patients, were analyzed using Wilcoxon signed-rank test and multivariate logistic regression with appropriate adjustments. Results: There were 19,409 patients, 16,277 blunt and 3,132 penetrating trauma. There were 3,571 Fd and 746 ED intubations. ED intubation was associated with increased risk of fatal outcome compared with nonintubated patient (adjusted odds ratio, 3.1; p < 0.0001) and field intubations (adjusted odds ratio, 3.0; p < 0.0001). ED-GCS score was not significantly different from Fd-GCS score, with 82% having the same GCS category. This was not the case for SBP, and only in 60% of the cases were ED-SBP and Fd-SBP in the same category. In 31% of the patients, the ED-SBP increased, and in 9% of cases, the ED-SBP decreased compared with Fd-SBP. This was true for both blunt and penetrating trauma. Both Fd-SBP and ED-SBP were independent predicators of fatal outcome, and mortality rate significantly increased if ED-SBP category decreased compared with Fd-SBP. Conclusion: Early field intubation was associated with a decreased risk of fatal outcome compared with ED intubation. ED-GCS score was not significantly different from Fd-GCS score, and either one can be used to predict fatal outcome. However, ED-SBP was different from Fd-SBP in 40% of the patients, with the majority of cases having higher ED-SBP. Although ED-SBP was a better predictor of outcome, the best model is achieved when both ED and field SBP are used.

KW - Blood pressure

KW - Blunt

KW - Emergency department

KW - Field

KW - Glasgow Coma Scale score

KW - Hypotension

KW - Intubation

KW - Mortality

KW - Outcomes

KW - Penetrating

KW - Prehospital

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=2942739031&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2942739031&partnerID=8YFLogxK

U2 - 10.1097/01.TA.0000123036.20919.4B

DO - 10.1097/01.TA.0000123036.20919.4B

M3 - Article

C2 - 15179242

AN - SCOPUS:2942739031

VL - 56

SP - 1029

EP - 1032

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -