Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain)
| Autor: | Tomás Belzunegui Otano, José Luis Gómez de Segura Nieva, Mercedes Marraco Boncompte, Alfredo Echarri Sucunza, Clint Jean Louis, Maria Segui-Gomez |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Emergency Medical Services Adolescent Logistic regression law.invention law Risk Factors Health care medicine Humans Hospital Mortality Prospective Studies Intensive care medicine Prospective cohort study Child Aged Aged 80 and over business.industry Multiple Trauma Odds ratio Revised Trauma Score Middle Aged Models Theoretical Intensive care unit Confidence interval Logistic Models Spain Child Preschool Emergency medicine Multivariate Analysis Emergency Medicine Injury Severity Score Female Comprehensive Health Care France business |
| Zdroj: | The Journal of emergency medicine. 37(2) |
| ISSN: | 0736-4679 |
| Popis: | Background: Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of “comprehensive care” can prevent deaths and disabilities as well as limit the severity and pain caused by trauma. Objective: To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain. Material and Methods: A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center “112,” pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. Results: There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1–13.1), RTS (OR 0.58, 95% CI 0.5–0.7), and ISS score (OR 1.05, 95% CI 1.0–1.1). Conclusion: Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others. |
| Databáze: | OpenAIRE |
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