Interesting abstract

[Guest guest]

171: Scene Time Does Not Impact Mortality in Trauma Patients

M.T. Cudnika, C.D. Newgarda, M.R. Sayrea and L.J. Whitea

The Ohio State University Medical Center, Columbus, OH; Oregon Health &

Science University, Portland, OR

Study Objectives

Time to definitive care is believed by many to be of the utmost importance

for critically injured patients. Researchers in the state of New York found

no association between total out-of-hospital time and mortality in such

patients. This study evaluates the effect of scene time on mortality for

injured patients.

Methods

Retrospective, observational cohort study of consecutive adult trauma

patients (>15 years old) transported by ground or air directly from the

scene to a regional Level 1 trauma center in a large, metropolitan area from

January 2001 through December 2006 who were admitted for at least 2 days or

died before 2 days. Interhospital transfers were excluded. Multiple

imputation was employed to maximize the number of subjects analyzed.

Univariate analysis identified variables associated with mortality and scene

time. A multivariate logistic regression was developed to identify any

association between scene time and mortality in trauma patients, adjusting

for potential confounders (age, mode of transport) and injury severity

(injury severity score {ISS}, revised trauma score {RTS}). Model performance

was assessed via area under the receiver operator characteristic (ROC)

curve.

Results

4, 561 patients were included. 59.9% were transported by air. The median ISS

was 10, and overall mortality was 5.2%. Mean scene time did not differ

between survivors (14.4 minutes) and non-survivors (15.3 minutes). The final

model included: age, ISS, RTS, and mode of transport to test the association

of scene time on mortality. Scene time (odds ratio {OR} 0.98; 95% Confidence

Interval {CI} 0.96-1.01, p=0.17) was the only factor not associated with

mortality. This relationship persisted when stratified by those with and

without out-of-hospital intubation (OR 0.98; 95% CI 0.94-1.02; OR 0.99; 95%

CI 0.95-1.02, respectively). For those patients with a scene time above the

mean (14.5 minutes) no observable increase in mortality was seen (OR 0.79;

95% CI 0.51-1.22, p=0.25). A similar relationship was seen when stratified

by ground vs. air transport, blunt vs. penetrating trauma, GCS <9, and by

those with a out-of-hospital SBP of <90. No scene time interval (in

10-minute increments) was found to be associated with an increase in

mortality. The area under the ROC curve was 89.4.

Conclusion

Scene time is not a significant predictor of mortality in trauma patients

transported to a Level 1 trauma center.

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[Guest guest]

Not sure, but this fits with Lerner's study from New York. Also,

there is an increasing trend for people to stop at lower level hospitals

before transport to a trauma center. Ken Mattox mentioned that yesterday in

the Baltimore Sun article where a bunch of us were interviewed.

http://www.baltimoresun.com/news/health/bal-te.medevac05oct05,0,6358239.stor

y

Acad Emerg Med. 2003 Sep;10(9):949-54. Links

Is total out-of-hospital time a significant predictor of trauma patient

mortality?

Lerner EB, Billittier AJ, Dorn JM, Wu YW.

Department of Emergency Medicine, The University at Buffalo, State

University of New York, USA. brooke_lerner@...

OBJECTIVE: To determine if there is an association between total

out-of-hospital time and trauma patient mortality.

METHODS: A retrospective review was performed of a convenience sample of

consecutive medical records for all admitted patients transported by

helicopter or ambulance from the scene of injury to the regional trauma

center. Descriptive and univariate analyses were conducted to determine

which variables were associated with patient mortality and total

out-of-hospital time. Multiple predictors logistic regression was used to

determine if total out-of-hospital time was associated with trauma patient

outcome, while controlling for the variables associated with trauma patient

mortality.

RESULTS: Of the 2,925 patients who were transported from the scene, 1,877

met the inclusion criteria. Six percent (116) did not survive. The multiple

predictors model included CUPS (critical, unstable, potentially unstable,

stable) status, patient age, Injury Severity Score, Revised Trauma Score,

and total out-of-hospital time as predictors of mortality. Total

out-of-hospital time (odds ratio 0.987; p = 0.092) was the only variable not

found to be a significant predictor of mortality.

CONCLUSIONS: Provider-assigned CUPS status, patient age, Injury Severity

Score, and Revised Trauma Score all were significant predictors of trauma

patient mortality. Total out-of-hospital time was not associated with

mortality

From: Paramedicine [mailto:Paramedicine ] On

Behalf Of Bilwith1l@...

Sent: Monday, October 06, 2008 9:21 AM

To: Paramedicine

Subject: Re: Interesting abstract

Interesting indeed. So where should we fit this in with ems vs non ems

transport studies?

Sent from my Verizon Wireless BlackBerry