Decreased mortality after prehospital interventions in severely injured trauma patients

Jonathan P. Meizoso, Evan J. Valle, Casey J. Allen, Juliet J. Ray, Jassin M. Jouria, Laura F. Teisch, David V Shatz, Nicholas Namias, Carl I. Schulman, Kenneth G. Proctor

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

BACKGROUND We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)227-231
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number2
DOIs
StatePublished - Aug 6 2015

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Injury Severity Score
Mortality
Wounds and Injuries
Air
Emergency Medical Services
Coma
Advanced Cardiac Life Support
Tourniquets
Nonpenetrating Wounds
Decompression
Burns
Intubation
Needles
Epidemiologic Studies
Traumatic Brain Injury
Incidence

Keywords

  • interventions
  • lifesaving
  • Prehospital
  • scoop and run
  • stay and play

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Meizoso, J. P., Valle, E. J., Allen, C. J., Ray, J. J., Jouria, J. M., Teisch, L. F., ... Proctor, K. G. (2015). Decreased mortality after prehospital interventions in severely injured trauma patients. Journal of Trauma and Acute Care Surgery, 79(2), 227-231. https://doi.org/10.1097/TA.0000000000000748

Decreased mortality after prehospital interventions in severely injured trauma patients. / Meizoso, Jonathan P.; Valle, Evan J.; Allen, Casey J.; Ray, Juliet J.; Jouria, Jassin M.; Teisch, Laura F.; Shatz, David V; Namias, Nicholas; Schulman, Carl I.; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 2, 06.08.2015, p. 227-231.

Research output: Contribution to journalArticle

Meizoso, JP, Valle, EJ, Allen, CJ, Ray, JJ, Jouria, JM, Teisch, LF, Shatz, DV, Namias, N, Schulman, CI & Proctor, KG 2015, 'Decreased mortality after prehospital interventions in severely injured trauma patients', Journal of Trauma and Acute Care Surgery, vol. 79, no. 2, pp. 227-231. https://doi.org/10.1097/TA.0000000000000748
Meizoso, Jonathan P. ; Valle, Evan J. ; Allen, Casey J. ; Ray, Juliet J. ; Jouria, Jassin M. ; Teisch, Laura F. ; Shatz, David V ; Namias, Nicholas ; Schulman, Carl I. ; Proctor, Kenneth G. / Decreased mortality after prehospital interventions in severely injured trauma patients. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 2. pp. 227-231.
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AU - Valle, Evan J.

AU - Allen, Casey J.

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AU - Jouria, Jassin M.

AU - Teisch, Laura F.

AU - Shatz, David V

AU - Namias, Nicholas

AU - Schulman, Carl I.

AU - Proctor, Kenneth G.

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N2 - BACKGROUND We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

AB - BACKGROUND We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

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KW - stay and play

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