International comparison of prehospital trauma care systems

Bahman Sayyar Roudsari, Avery B. Nathens, Peter Cameron, Ian Civil, Russel L. Gruen, Thomas D. Koepsell, Fiona E. Lecky, Rolf L. Lefering, Moishe Liberman, Charles N. Mock, Hans Jörg Oestern, Thomas A. Schildhauer, Christian Waydhas, Frederick P. Rivara

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective: Given the recent emphasis on developing prehospital trauma care globally, we embarked upon a multicentre study to compare trauma patients' outcome within and between countries with technician-operated advanced life support (ALS) and physician-operated (Doc-ALS) emergency medical service (EMS) systems. These environments represent the continuum of prehospital care in high income countries with more advanced prehospital trauma care systems. Methods: Five countries with ALS-EMS system and four countries with Doc-ALS EMS system provided us with de-identified patient-level data from their national or local trauma registries. Generalised linear latent and mixed models was used in order to compare emergency department (ED) shock rate (systolic blood pressure (SBP) <90 mmHg) and early trauma fatality rate (i.e. death during the first 24 h after hospital arrival) between ALS and Doc-ALS EMS systems. Logistic regression was used to compare outcomes of interest among different countries, accounting for within-system correlation in patient outcomes. Results: After adjustment for patient age, sex, type and mechanism of injury, injury severity score and SBP at scene, the ED shock rate did not vary significantly between Doc-ALS and ALS systems (OR: 1.16, 95% CI: 0.73-1.91). However, the early trauma fatality rate was significantly lower in Doc-ALS EMS systems compared with ALS EMS systems (OR: 0.70, 95% CI: 0.54-0.91). Furthermore, we found a considerable heterogeneity in patient outcomes among countries even with similar type of EMS systems. Conclusion: These findings suggest that prehospital trauma care systems that dispatch a physician to the scene may be associated with lower early trauma fatality rates, but not necessarily with significantly better outcomes on other clinical measures. The reasons for these findings deserve further studies.

Original languageEnglish (US)
Pages (from-to)993-1000
Number of pages8
JournalInjury
Volume38
Issue number9
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

Fingerprint

Emergency Medical Services
Wounds and Injuries
Blood Pressure
Hospital Emergency Service
Shock
Life Support Systems
Physicians
Injury Severity Score
Continuity of Patient Care
Multicenter Studies
Registries
Logistic Models
Mortality

Keywords

  • Clustered study
  • Emergency medical services (EMS)
  • Injury
  • International
  • Intracluster correlation coefficient (ICC)
  • Mortality
  • Shock rate
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Sayyar Roudsari, B., Nathens, A. B., Cameron, P., Civil, I., Gruen, R. L., Koepsell, T. D., ... Rivara, F. P. (2007). International comparison of prehospital trauma care systems. Injury, 38(9), 993-1000. https://doi.org/10.1016/j.injury.2007.03.028

International comparison of prehospital trauma care systems. / Sayyar Roudsari, Bahman; Nathens, Avery B.; Cameron, Peter; Civil, Ian; Gruen, Russel L.; Koepsell, Thomas D.; Lecky, Fiona E.; Lefering, Rolf L.; Liberman, Moishe; Mock, Charles N.; Oestern, Hans Jörg; Schildhauer, Thomas A.; Waydhas, Christian; Rivara, Frederick P.

In: Injury, Vol. 38, No. 9, 01.09.2007, p. 993-1000.

Research output: Contribution to journalArticle

Sayyar Roudsari, B, Nathens, AB, Cameron, P, Civil, I, Gruen, RL, Koepsell, TD, Lecky, FE, Lefering, RL, Liberman, M, Mock, CN, Oestern, HJ, Schildhauer, TA, Waydhas, C & Rivara, FP 2007, 'International comparison of prehospital trauma care systems', Injury, vol. 38, no. 9, pp. 993-1000. https://doi.org/10.1016/j.injury.2007.03.028
Sayyar Roudsari B, Nathens AB, Cameron P, Civil I, Gruen RL, Koepsell TD et al. International comparison of prehospital trauma care systems. Injury. 2007 Sep 1;38(9):993-1000. https://doi.org/10.1016/j.injury.2007.03.028
Sayyar Roudsari, Bahman ; Nathens, Avery B. ; Cameron, Peter ; Civil, Ian ; Gruen, Russel L. ; Koepsell, Thomas D. ; Lecky, Fiona E. ; Lefering, Rolf L. ; Liberman, Moishe ; Mock, Charles N. ; Oestern, Hans Jörg ; Schildhauer, Thomas A. ; Waydhas, Christian ; Rivara, Frederick P. / International comparison of prehospital trauma care systems. In: Injury. 2007 ; Vol. 38, No. 9. pp. 993-1000.
@article{e72e353b87f244a5819b1a6eedc941e5,
title = "International comparison of prehospital trauma care systems",
abstract = "Objective: Given the recent emphasis on developing prehospital trauma care globally, we embarked upon a multicentre study to compare trauma patients' outcome within and between countries with technician-operated advanced life support (ALS) and physician-operated (Doc-ALS) emergency medical service (EMS) systems. These environments represent the continuum of prehospital care in high income countries with more advanced prehospital trauma care systems. Methods: Five countries with ALS-EMS system and four countries with Doc-ALS EMS system provided us with de-identified patient-level data from their national or local trauma registries. Generalised linear latent and mixed models was used in order to compare emergency department (ED) shock rate (systolic blood pressure (SBP) <90 mmHg) and early trauma fatality rate (i.e. death during the first 24 h after hospital arrival) between ALS and Doc-ALS EMS systems. Logistic regression was used to compare outcomes of interest among different countries, accounting for within-system correlation in patient outcomes. Results: After adjustment for patient age, sex, type and mechanism of injury, injury severity score and SBP at scene, the ED shock rate did not vary significantly between Doc-ALS and ALS systems (OR: 1.16, 95{\%} CI: 0.73-1.91). However, the early trauma fatality rate was significantly lower in Doc-ALS EMS systems compared with ALS EMS systems (OR: 0.70, 95{\%} CI: 0.54-0.91). Furthermore, we found a considerable heterogeneity in patient outcomes among countries even with similar type of EMS systems. Conclusion: These findings suggest that prehospital trauma care systems that dispatch a physician to the scene may be associated with lower early trauma fatality rates, but not necessarily with significantly better outcomes on other clinical measures. The reasons for these findings deserve further studies.",
keywords = "Clustered study, Emergency medical services (EMS), Injury, International, Intracluster correlation coefficient (ICC), Mortality, Shock rate, Trauma",
author = "{Sayyar Roudsari}, Bahman and Nathens, {Avery B.} and Peter Cameron and Ian Civil and Gruen, {Russel L.} and Koepsell, {Thomas D.} and Lecky, {Fiona E.} and Lefering, {Rolf L.} and Moishe Liberman and Mock, {Charles N.} and Oestern, {Hans J{\"o}rg} and Schildhauer, {Thomas A.} and Christian Waydhas and Rivara, {Frederick P.}",
year = "2007",
month = "9",
day = "1",
doi = "10.1016/j.injury.2007.03.028",
language = "English (US)",
volume = "38",
pages = "993--1000",
journal = "Injury",
issn = "0020-1383",
publisher = "Elsevier Limited",
number = "9",

}

TY - JOUR

T1 - International comparison of prehospital trauma care systems

AU - Sayyar Roudsari, Bahman

AU - Nathens, Avery B.

AU - Cameron, Peter

AU - Civil, Ian

AU - Gruen, Russel L.

AU - Koepsell, Thomas D.

AU - Lecky, Fiona E.

AU - Lefering, Rolf L.

AU - Liberman, Moishe

AU - Mock, Charles N.

AU - Oestern, Hans Jörg

AU - Schildhauer, Thomas A.

AU - Waydhas, Christian

AU - Rivara, Frederick P.

PY - 2007/9/1

Y1 - 2007/9/1

N2 - Objective: Given the recent emphasis on developing prehospital trauma care globally, we embarked upon a multicentre study to compare trauma patients' outcome within and between countries with technician-operated advanced life support (ALS) and physician-operated (Doc-ALS) emergency medical service (EMS) systems. These environments represent the continuum of prehospital care in high income countries with more advanced prehospital trauma care systems. Methods: Five countries with ALS-EMS system and four countries with Doc-ALS EMS system provided us with de-identified patient-level data from their national or local trauma registries. Generalised linear latent and mixed models was used in order to compare emergency department (ED) shock rate (systolic blood pressure (SBP) <90 mmHg) and early trauma fatality rate (i.e. death during the first 24 h after hospital arrival) between ALS and Doc-ALS EMS systems. Logistic regression was used to compare outcomes of interest among different countries, accounting for within-system correlation in patient outcomes. Results: After adjustment for patient age, sex, type and mechanism of injury, injury severity score and SBP at scene, the ED shock rate did not vary significantly between Doc-ALS and ALS systems (OR: 1.16, 95% CI: 0.73-1.91). However, the early trauma fatality rate was significantly lower in Doc-ALS EMS systems compared with ALS EMS systems (OR: 0.70, 95% CI: 0.54-0.91). Furthermore, we found a considerable heterogeneity in patient outcomes among countries even with similar type of EMS systems. Conclusion: These findings suggest that prehospital trauma care systems that dispatch a physician to the scene may be associated with lower early trauma fatality rates, but not necessarily with significantly better outcomes on other clinical measures. The reasons for these findings deserve further studies.

AB - Objective: Given the recent emphasis on developing prehospital trauma care globally, we embarked upon a multicentre study to compare trauma patients' outcome within and between countries with technician-operated advanced life support (ALS) and physician-operated (Doc-ALS) emergency medical service (EMS) systems. These environments represent the continuum of prehospital care in high income countries with more advanced prehospital trauma care systems. Methods: Five countries with ALS-EMS system and four countries with Doc-ALS EMS system provided us with de-identified patient-level data from their national or local trauma registries. Generalised linear latent and mixed models was used in order to compare emergency department (ED) shock rate (systolic blood pressure (SBP) <90 mmHg) and early trauma fatality rate (i.e. death during the first 24 h after hospital arrival) between ALS and Doc-ALS EMS systems. Logistic regression was used to compare outcomes of interest among different countries, accounting for within-system correlation in patient outcomes. Results: After adjustment for patient age, sex, type and mechanism of injury, injury severity score and SBP at scene, the ED shock rate did not vary significantly between Doc-ALS and ALS systems (OR: 1.16, 95% CI: 0.73-1.91). However, the early trauma fatality rate was significantly lower in Doc-ALS EMS systems compared with ALS EMS systems (OR: 0.70, 95% CI: 0.54-0.91). Furthermore, we found a considerable heterogeneity in patient outcomes among countries even with similar type of EMS systems. Conclusion: These findings suggest that prehospital trauma care systems that dispatch a physician to the scene may be associated with lower early trauma fatality rates, but not necessarily with significantly better outcomes on other clinical measures. The reasons for these findings deserve further studies.

KW - Clustered study

KW - Emergency medical services (EMS)

KW - Injury

KW - International

KW - Intracluster correlation coefficient (ICC)

KW - Mortality

KW - Shock rate

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=34548184448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548184448&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2007.03.028

DO - 10.1016/j.injury.2007.03.028

M3 - Article

VL - 38

SP - 993

EP - 1000

JO - Injury

JF - Injury

SN - 0020-1383

IS - 9

ER -