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The Effect of Prehospital Transport Time on the Mortality from Traumatic Injury

Published online by Cambridge University Press:  28 June 2012

Roland W. Petri ,
Alan Dyer  and
John Lumpkin
Roland W. Petri*
Affiliation:
Division of Emergency Medicine, Northwestern University Medical School, Chicago, Illinois
Alan Dyer
Affiliation:
Department of Preventive Medicine, Northwestern University Medical School, Chicago, Illinois
John Lumpkin
Affiliation:
Division of Emergency Medicine, Northwestern University Medical School, Chicago, Illinois
*
Division of Emergency Medicine, Northwestern University Medical School, 216 E. Superior St., 1st Floor, Chicago, Illinois, 60611USA
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Abstract

Objective:

To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital.

Design:

Review of data contained within the Illinois Trauma Registry encompassing the period from fall 1989 through spring 1991.

Participants:

A total of 5,215 injured persons with an Injury Severity Score (ISS) >10, cared for in an Illinois level-I or -II trauma center outside of the city of Chicago.

Measurements:

Injury severity expressed as ISS, scene time (ST), transport time (TrT), total emergency medical services time (TEMST), and outcome were determined for each patient. Patients were stratified into groups on the basis of ISS.

Results:

Patient outcomes were significantly different statistically between ISS groups (p <0.001, X2). Mean ST and TEMST, but not TrT, were significantly different statistically between ISS groups (p <0.001, analysis of variance). Lower ISS was associated with longer times. Mean ST, TrT, and TEMST were significantly different statistically between survivors and nonsurvivors (p <0.001, two-sample t-tests). Survival was associated with longer times. Each of the mean times remained significantly different between survivors and nonsurvivors after controlling for severity of injury (p <0.001, two-way analysis of variance).

Conclusion:

No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time <90 minutes exerted a significant adverse effect upon survival.

Keywords

injury severity scoremorbidity ratemortality rateoutcomeprehospital timesprehospital time thresholdscene timesurvivaltransport timetraumatrauma registry
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 1 , March 1995 , pp. 24 - 29
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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Footnotes

*

Presented at the annual meetings of the Illinois College of Emergency Physicians, Oak Brook, Illinois, May 1992 and at the Society for Academic Emergency Medicine, Toronto, Canada, May 1992

References

1. Budnick, I.D., Chaiken, BP: The probability of dying of injuries by the year 2000. JAMA 1985;254:3350–3352.CrossRefGoogle ScholarPubMed
2. Walt, AJ: Foreword. In: Moore, EE, Mattox, KL, Feliciano, DV (eds): Trauma, 2nd ed. East Norwalk, Conn., Appleton & Lange, 1991, p xvii.Google Scholar
3. Trunkey, DD: Presidential address: On the nature of things that go bang in the night. Surgery 1982;92:123–132.Google Scholar
4. Kelly, P, Sanson, T, Strange, G, et al. : A prospective study of the impact of helmet usage on motorcycle trauma. Ann Emerg Med 1991;20:852–856.CrossRefGoogle ScholarPubMed
5. West, JG, Trunkey, DD, Lim, RC: Systems of trauma care: A study of two counties. Arch Surg 1979;114:445–460.Google ScholarPubMed
6. West, JG, Gales, RH, Gazzaniga, AB: Impact of regionalization: The Orange County experience. Arch Surg 1983;18:740–744.CrossRefGoogle Scholar
7. Cales, RH: Trauma mortality in Orange County: The effect of implementation of a regional trauma system. Ann Emerg Med 1984;13:1–10.CrossRefGoogle ScholarPubMed
8. Shackford, SR, Hollingworth-Fridlund, P, Cooper, GF, et al. : The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: A preliminary report. J Trauma 1986;26:812–820.CrossRefGoogle ScholarPubMed
9. Rhodes, M, Aronson, J, Moerkirk, G, et al. : Quality of life after the trauma center. J Trauma 1988;28:931–936.CrossRefGoogle ScholarPubMed
10. Thal, ER, Rochon, RB: Inner-city trauma centers: Financial burdens or community saviors? Surg Clin North Am 1991;71:209–219.CrossRefGoogle ScholarPubMed
11. Champion, HR, Sacco, WJ, Gainer, PS, et al. : The effect of medical direction on trauma triage. J Trauma 1988;28:235–239.CrossRefGoogle ScholarPubMed
12. Boyd, DR: Computerized trauma registry. J Trauma 1971;11:449–450.CrossRefGoogle Scholar
13. Boyd, DR, Lowe, RJ, Baker, RJ, et al. : A trauma registry: A new computer method for the multifactorial evaluation of a major health problem. JAMA 1973:223:422–428.CrossRefGoogle ScholarPubMed
14. Boyd, DR, Rappaport, DM, Marbarger, JP, et al. : Computerized trauma registry: A new method for categorizing physical injuries. Aerospace Med 1971;42:607–615.Google ScholarPubMed
15. Illinois Department of Public Health: Illinois Trauma Registry Procedure Manual—Version 1.2. Springfield, Ill., IDPH.Google Scholar
16. Baker, SP, O'Neill, B, Haddon, W, et al. : The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.CrossRefGoogle ScholarPubMed
17.Baker, SP, O'Neill, B: The injury severity score: An update. J Trauma 1976;16:882–885.CrossRefGoogle ScholarPubMed
18. Semmlow, JL, Cone, R: Utility of the injury severity score: A confirmation. Health Sent Res 1976;11:45–52.Google ScholarPubMed
19. Copes, WS, Champion, HR, Sacco, WJ, et al. : The injury severity score revisited. J Trauma 1988;28:69–76.CrossRefGoogle ScholarPubMed
20. American Association for Automotive Medicine: The Abbreviated Injury Scale (AIS)—1985 Revision. Des Plaines, Ill., AAAM: 1985.Google Scholar
21. Trunkey, DD: Trauma. Sci Amer 1983;249:28–35.CrossRefGoogle ScholarPubMed
22. Cales, RH, Trunkey, DD: Preventable trauma deaths: A review of trauma care systems development. JAMA 1985;254:1059–1063.CrossRefGoogle ScholarPubMed
23. Potter, D, Goldstein, G, Fung, SC, et al. : A controlled trial of prehospital advanced life support in trauma. Ann Emerg Med 1988;17:582–588.CrossRefGoogle ScholarPubMed
24. Reines, HD, Bartlett, RL, Chudy, NE, et al. : Is advanced life support appropriate for victims of motor vehicle accidents? The South Carolina highway trauma project. J Trauma 1988;28:563–570.CrossRefGoogle ScholarPubMed
25. Gold, CR: Prehospital advanced life support vs. “scoop and run” in trauma management. Ann Emerg Med 1987;16:797–801.CrossRefGoogle ScholarPubMed
26. Smith, JP, Bodai, BI, Hill, AS, et al. : Prehospital stabilization of critically injured patients: A failed concept. J Trauma 1985;25:65–70.CrossRefGoogle ScholarPubMed
27. Jacobs, LM, Sinclair, A, Beiser, A, et al. : Prehospital advanced life support: Benefits in trauma. J Trauma 1984;24:8–13.CrossRefGoogle ScholarPubMed
28. Honigman, B, Rohweder, K, Moore, EE, et al. : Prehospital advanced trauma life support for penetrating cardiac wounds. Ann Emerg Med 1990;19:145–150.CrossRefGoogle ScholarPubMed
29. Clevenger, FW, Yarbrough, DR, Reines, HD: Resuscitative thoracotomy: The effect of field time on outcome. J Trauma 1988;28:441–445.CrossRefGoogle ScholarPubMed
30. Ivatury, RR, Nallathambi, MN, Roberge, RJ, et al. : Penetrating thoracic injuries: In-field stabilization vs. prompt transport. J Trauma 1987;27:1066–1073.CrossRefGoogle ScholarPubMed
31. Gervin, AS, Fischer, RP: The importance of prompt transport in salvage of patients with penetrating heart wounds. J Trauma 1982;22:443–448.CrossRefGoogle ScholarPubMed
32. Cwinn, AA, Pons, PT, Moore, EE, et al. : Prehospital advanced trauma life support for critical blunt trauma victims. Ann Emerg Med 1987:16:399–403.CrossRefGoogle ScholarPubMed
33. Pepe, PE, Wyatt, CH, Bickell, WH, et al. : The relationship between total prehospital time and outcome in hypotensive victims of penetrating injuries. Ann Emerg Med 1987;16:293–297.CrossRefGoogle ScholarPubMed
34. Boyd, CR, Tolson, MA, Copes, WS: Evaluating trauma care: The TRISS method, J Trauma 1987;27:370–378.CrossRefGoogle ScholarPubMed
35. Baxt, WG, Bern, CC, Epperson, MD, et al. : The failure of prehospital trauma prediction rules to classify trauma patients accurately. Ann Emerg Med 1989;18:1–8.CrossRefGoogle ScholarPubMed
36. Baxt, WG, Jones, G, Fortlage, D: The trauma triage rule: A new, resource based approach to the prehospital identification of major trauma victims. Ann Emerg Med 1990;19:1401–1406.CrossRefGoogle Scholar
37. Koehler, JJ, Malafa, SA, Hillesland, J, et al. : A multicenter validation of the prehospital index. Ann Emerg Med 1987;16:380–385.CrossRefGoogle ScholarPubMed
38. Ornato, J, Mlinek, EJ, Graren, FJ, et al. : Ineffectiveness of the trauma score and the CRAMS scale for accurately triaging patients to trauma centers. Ann Emerg Med 1985;14:1061–1064.CrossRefGoogle ScholarPubMed
39. Kilberg, L, Clemmer, TP, Clawson, J, et al. : Effectiveness of implementing a trauma triage system on outcome: A prospective evaluation. J Trauma 1988;28:1493–1498.CrossRefGoogle ScholarPubMed
40. Eichelberger, MR, Gotschall, CS, Sacco, WJ, et al. : A comparison of the trauma score, the revised trauma score; and the pedialric trauma score. Ann Emerg Med 1989;18:1053–1058.CrossRefGoogle ScholarPubMed
41. Morris, JA, Auerbach, PS, Marshall, GA, et al. : The trauma score as a triage tool in the prehospital setting. JAMA 1986;256:1319–1325.CrossRefGoogle ScholarPubMed
42. Knudson, P, Frecerri, CA, DeLateur, JA: Improving the field triage of major trauma victims. J Trauma 1988;28:602–606.CrossRefGoogle ScholarPubMed