IMPACT OF ON-SITE CARE, PREHOSPITAL TIME, AND LEVEL OF IN-HOSPITAL CARE ON SURVIVAL IN SEVERELY INJURED PATIENTS

TLDR

To test whether on‑site care, total prehospital time, and hospital level affect short‑term survival in severely injured patients. The study used a prospective case‑referent design on 360 patients drawn from an 8007‑person trauma cohort to examine these associations. Advanced Life Support at the scene was not linked to survival, while treatment at a level I compatible hospital reduced odds of death by 38% (approaching significance) and prehospital times over 60 minutes tripled the odds of death, supporting regionalization of trauma care and showing no benefit of ALS.

Abstract

A sample of 360 severely injured patients was selected from a cohort of 8007 trauma victims followed prospectively from the time of injury to death or discharge. A case referent study was used to test the association between on-site care, total prehospital time, and level of care at the receiving hospital with short-term survival. Multiple logistic regression analyses showed that use of Advanced Life Support (ALS) at the scene was not associated with survival, whereas treatment at a level I compatible hospital was associated with a 38% reduction in the odds of dying, which approached statistical significance. Total prehospital time over 60 minutes was associated with a statistically significant adjusted relative odds of dying (OR = 3.0). The results of this study support the need for regionalzation of trauma care and fail to show a benefit associated with ALS.