National Variability in Out-of-Hospital Treatment After Traumatic Injury

Eileen M. Bulger, Avery B. Nathens, Frederick P. Rivara, Ellen MacKenzie, Daniel R. Sabath, Gregory Jurkovich

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Study objective: The optimal out-of-hospital treatment for trauma patients remains a subject of national debate. Researchers designing future studies to address these issues must understand the variability in treatment that exists across the United States. We define the variability in the out-of-hospital treatment provided to trauma patients in the United States. Methods: This was a retrospective analysis of prospectively collected data for a cohort study of trauma outcomes. The study was conducted at 15 urban or suburban regions across the United States, 18 Level I trauma centers and 51 nontrauma centers. We used a weighted population sample based on data from all hospital trauma deaths and a sample of patients discharged between January 2001 and December 2002. Entry criteria included at least 1 body region with an Abbreviated Injury Score greater than 3 and age between 18 and 84 years. Exclusion criteria were patient age greater than 65 years and isolated hip fractures and patients with burns. Results: Complete out-of-hospital data were available for 3,357 patients, representing a weighted population sample of 9,929 patients. Out-of-hospital treatment varied substantially among the regions, including out-of-hospital intubation (5% to 48%), use of neuromuscular blocking agents or sedatives to facilitate intubation (0% to 100%), surgical airway access (0.1% to 3.5%), peripheral and central intravenous access (22% to 95%), and needle thoracentesis (0% to 5%). Conclusion: There is considerable national variability in out-of-hospital procedures performed for trauma patients.

Original languageEnglish (US)
Pages (from-to)293-301
Number of pages9
JournalAnnals of Emergency Medicine
Volume49
Issue number3
DOIs
StatePublished - Mar 1 2007
Externally publishedYes

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Wounds and Injuries
Therapeutics
Intubation
Neuromuscular Blocking Agents
Body Regions
Trauma Centers
Hip Fractures
Hypnotics and Sedatives
Burns
Population
Needles
Cohort Studies
Research Personnel

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

National Variability in Out-of-Hospital Treatment After Traumatic Injury. / Bulger, Eileen M.; Nathens, Avery B.; Rivara, Frederick P.; MacKenzie, Ellen; Sabath, Daniel R.; Jurkovich, Gregory.

In: Annals of Emergency Medicine, Vol. 49, No. 3, 01.03.2007, p. 293-301.

Research output: Contribution to journalArticle

Bulger, Eileen M. ; Nathens, Avery B. ; Rivara, Frederick P. ; MacKenzie, Ellen ; Sabath, Daniel R. ; Jurkovich, Gregory. / National Variability in Out-of-Hospital Treatment After Traumatic Injury. In: Annals of Emergency Medicine. 2007 ; Vol. 49, No. 3. pp. 293-301.
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