More Evidence Against the Golden Hour

[Guest guest]

Am Surg. 2008 Oct;74(10):930-4.

Impact on patient outcomes after closure of an adjacent trauma center.

Yaghoubian A, RJ, Putnam BA, De Virgilio C.

Department of Surgery, Harbor-UCLA Medical Center, Torrance, California

90509, USA.

In 2005, a major Level I trauma center closed in Los Angeles County, leading

to media speculation that the sudden expansion of our catchment area would

adversely affect outcome. We sought to determine whether the closure led to

longer transport times and increased trauma morbidity and mortality at our

Level I trauma center. Annual patient volume, paramedic transport times,

injury severity score (ISS), mechanism of injury, complication rate, and

mortality were retrospectively compared between two time periods, Period 1

(1997-2005, before closure) and Period 2 (March 1, 2005 to March 1, 2006,

after closure), using multivariable logistic regression models. Median

monthly patient volume rose from 123 patients to 190 patients in Period 2 (P

< 0.01). Median transport time increased from 12 to 13 minutes (P = 0.004)

and median ISS increased from four to five (P < 0.01) in Period 2. The

proportion of patients with ISS > 15 increased from 17 to 24 per cent as

well (P < 0.01). After accounting injury severity, the adjusted mortality

rate decreased in Period 2 (odds ratio 0.69, P = 0.03) and the adjusted

complication rate was unchanged (odds ratio 1.16, P = 0.2). In conclusion,

the closure of a Level I trauma center resulted in a significant increase in

trauma patient volume and injury severity, as well as a slight increase in

paramedic transport times. However, the adjusted complication rate was

unchanged, and the adjusted mortality rate actually improved.

Best line: " ...and the adjusted mortality rate improved. "

[Guest guest]

>

> Best line: " ...and the adjusted mortality rate improved. "

>

Deads dead aint it?

[Guest guest]

I am not sure how this is evidence against the golden hour. I believe the

increase in median transport time was only approximately 1 minute. It may

actually support the theory that an increase in volume at one center gives the

faculty and staff more repetition and experience in dealing with these types of

emergencies.

Bill Dunne