Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

Mamta Swaroop, David C. Straus, Ogo Agubuzu, Thomas J. Esposito, Carol R. Schermer, Marie L. Crandall

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Achieving definitive care within the «Golden Hour» by minimizing response times is a consistent goal of regional trauma systems. This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003. Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving. Patients with higher injury severity scores (ISS) were transported more quickly. Injury severity scores (ISS) ≥16 and emergency department (ED) hypotension (systolic blood pressure, SBP <90) strongly predicted mortality (P < 0.05 for each). In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05). This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001). Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner. Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival. These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

Original languageEnglish (US)
Pages (from-to)16-20
Number of pages5
JournalJournal of Emergencies, Trauma and Shock
Volume6
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Fingerprint

Thorax
Survival
Wounds and Injuries
Injury Severity Score
Mortality
Trauma Centers
Logistic Models
Blood Pressure
Thoracic Injuries
Hypotension
Reaction Time
Registries
Hospital Emergency Service
Cohort Studies
Software
Retrospective Studies

Keywords

  • Golden Hour
  • Penetrating trauma mortality
  • Pre-hospital transport time
  • Urban trauma systems

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma. / Swaroop, Mamta; Straus, David C.; Agubuzu, Ogo; Esposito, Thomas J.; Schermer, Carol R.; Crandall, Marie L.

In: Journal of Emergencies, Trauma and Shock, Vol. 6, No. 1, 01.2013, p. 16-20.

Research output: Contribution to journalArticle

Swaroop, Mamta ; Straus, David C. ; Agubuzu, Ogo ; Esposito, Thomas J. ; Schermer, Carol R. ; Crandall, Marie L. / Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma. In: Journal of Emergencies, Trauma and Shock. 2013 ; Vol. 6, No. 1. pp. 16-20.
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