Prehospital Time Following Traumatic Injury Is Independently Associated With the Need for In-Hospital Blood and Early Mortality for Specific Injury Types.

Autor: Zadorozny EV; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Lin HS; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Luther J; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Wisniewski SR; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Cotton BA; Department of Surgery, University of Houston School of Medicine, Houston, TX., Fox EE; Department of Surgery, University of Houston School of Medicine, Houston, TX., Harbrecht BG; Department of Surgery, University of Louisville School of Medicine, Louisville, KY., Joseph BA; Department of Surgery, University of Arizona Tucson College of Medicine, Tucson, AZ., Moore EE; Department of General Surgery, University of Colorado Denver Health, Denver, CO., Ostenmayer DG; Department of Emergency Medicine, University of Houston School of Medicine, Houston, TX., Patel MB; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN., Schreiber MA; Department of Surgery, Oregon Health & Science University, Portland, OR., Tatebe LC; Department of General/Trauma Surgery, University of Texas Southwestern Medical School, Dallas, TX., Todd SR; Department of Trauma Surgery, Grady Memorial Hospital, Atlanta, GA., Wilson C; Department of Surgery, Baylor College of Medicine, Houston, TX., Gruen DS; University of Pittsburgh School of Medicine, Pittsburgh, PA., Sperry JL; Department of General/Trauma Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA., Martin-Gill C; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA., Brown JB; Department of General/Trauma Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA., Guyette FX; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: guyefx@upmc.edu.
Jazyk: angličtina
Zdroj: Air medical journal [Air Med J] 2024 Jan-Feb; Vol. 43 (1), pp. 47-54. Date of Electronic Publication: 2023 Nov 28.
DOI: 10.1016/j.amj.2023.09.013
Abstrakt: Objective: Treating traumatic hemorrhage is time sensitive. Prehospital care and transport modes (eg, helicopter and ground) may influence in-hospital events. We hypothesized that prehospital time (on-scene time [OST] and total prehospital time [TPT]) and transport mode are associated with same-day transfusion and mortality. Furthermore, we sought to identify regions of anatomic injury that modify the relationship between prehospital time and outcomes in strata corresponding to transport types.
Methods: We obtained prehospital, in-hospital, and trauma registry data from an 8-center cohort of adult nonburn trauma patients from 2017 to 2022 directly transported from the scene to the hospital and having an Injury Severity Score (ISS) > 9 for the Task Order 1 project of the Linking Investigators in Trauma and Emergency Services research network. We excluded patients missing prehospital times, patients < 18 years of age, patients from interfacility transfers, and recipients of prehospital blood. Our same-day outcomes were in-hospital transfusions within 4 hours and 24-hour mortality. Each outcome was adjusted using multivariable logistic regression for covariates of prehospital phases (OST and TPT), mode of transport (helicopter and ground), age, sex, ISS, Glasgow Coma Scale motor subscale score < 6, and field hypotension (systolic blood pressure < 90 mm Hg). We evaluated the association of prehospital time on outcomes for scene missions by transport mode across severe injury patterns defined by Abbreviated Injury Scale > 2 body regions.
Results: Of 78,198 subjects, 34,504 were eligible for the study with a mean age of 47.6 ± 20.3 years, ISS of 18 ± 11, OST of 15.9 ± 9.5 minutes, and TPT of 48.7 ± 20.3 minutes. Adjusted for injury severity and demographic factors, transport type significantly modified the relationship between prehospital time and outcomes. The association of OST and TPT with the odds of 4-hour transfusion was absent for the ground emergency medical services (GEMS) cohort and present for the helicopter emergency medical services (HEMS) ambulance cohort, whereas these times were associated with decreased 24-hour mortality for both transport types. When stratifying by injury to most anatomic regions, OST and TPT were associated with a decreased need for 4-hour transfusions in the GEMS cohort. However, OST was associated with increased early transfusion only among patients with severe injuries of the thorax, and this association persisted after adjusting additionally for injury type (odds ratio [OR] = 1.03; 95% confidence interval [CI], 1.00-1.05; P = .02). The presence of polytrauma supported an association between prehospital time and decreased 24-hour mortality for the GEMS cohort (OST: OR = 0.97; 95% CI, 0.95-0.99; P < .01; TPT: OR = 0.99; 95% CI, 0.98-0.99; P = .02), whereas no injuries showed significant association of helicopter prehospital time on mortality after adjustment.
Conclusion: We determined that transport type affects the relationship between prehospital time and hospital outcomes (4-hour transfusion: positive relationship for HEMS and negative for GEMS, 24-hour mortality: negative for both transport types). Furthermore, we identified regions of anatomic injury that modify the relationship between prehospital time and outcomes in strata corresponding to transport types. Of these regions, most notable were severe isolated injuries to the thorax that supported a positive relationship between HEMS OST and 4-hour transfusions and polytrauma that showed a negative relationship between GEMS OST or TPT and 24-hour mortality after adjustment.
Competing Interests: Declaration of Competing Interest The author(s) have no relevant disclosures. There was no grant funding or financial support for this manuscript.
(Copyright © 2023 Air Medical Journal Associates. All rights reserved.)
Databáze: MEDLINE
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