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Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript



This study examined the association between lapsed time and trauma patients, suggesting that a shorter time to definitive care leads to a better outcome.


We used the Pan-Asian Trauma Outcome Study registry to analyze a retrospective cohort of 963 trauma patients who received surgical intervention or transarterial embolization within 2 h of injury in Asian countries between January 2016 and December 2020. Exposure measurement was recorded every 30 min from injury to definitive care. The 30 day mortality rate and functional outcome were studied using the Modified Rankin Scale ratings of 0–3 vs 4–6 for favorable vs poor functional outcomes, respectively. Subgroup analyses of different injury severities and patterns were performed.


The mean time from injury to definitive care was 1.28 ± 0.69 h, with cases categorized into the following subgroups: < 30, 30–60, 60–90, and 90–120 min. For all patients, a longer interval was positively associated with the 30 day mortality rate (p = 0.053) and poor functional outcome (p < 0.05). Subgroup analyses showed the same association in the major trauma (n = 321, p < 0.05) and torso injury groups (n = 388, p < 0.01) with the 30 day mortality rate and in the major trauma (p < 0.01), traumatic brain injury (n = 741, p < 0.05), and torso injury (p < 0.05) groups with the poor functional outcome.


Even within 2 h, a shorter time to definitive care is positively associated with patient survival and functional outcome, especially in the subgroups of major trauma and torso injury.

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Availability of data and materials

The data of this study are owned by the PATOS coordination center. The data were not freely available because of the regulations of PATOS organizations, but an application to get the data is possible, if the application is approved by the PATOS EXCO meeting mainly composing of data-contributing principal investigators from Asia countries. The contact of the PATOS coordination center is listed below. Ms. Suhee Agnes KIM, MPH. Laboratory of Emergency Medical Services, Biomedical Research Institute. Seoul National University Hospital, Seoul, South Korea. Tel: + 2 2072 4683; Mobile: + 82 10 8572 7715; Email:

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PATOS Clinical Research Network

Participating Nation Investigators: T.V. Ramakrishnan (India), Sabariah Faiwah Jamaluddin (Malaysia), Hideharu Tanaka (Japan), Bernadett Velasco (Philippines), Ki Jeong Hong (South Korea), Jen Tang Sun (Taiwan), Pairoj Khruekarnchana (Thailand), Saleh Fares LLC (United Arab Emirates), Do Ngoc Son (Vietnam).

Participating Site Investigators: Ramana Rao (GVK EMRI, India), George P. Abraham (Indian Institute of Emergency Medical Services, India), T.V. Ramakrishnan (Sri Ramachandra Medical Center, India), Sabariah Faiwah Jamaluddin (Sungai Buloh Hospital, Malaysia), Mohd Amin Bin Mohidin (Sultanah Aminah Hospital, Malaysia), Al-Hilmi Saim (Seri Manjung Hospital, Malaysia), Lim Chee Kean (Pulau Pinang Hospital, Malaysia), Cecilia Anthonysamy (Serdang Hospital, Malaysia), Shah Jahan Din Mohd Yssof (Kuala Lumpur Hospital, Malaysia), Kang Wen Ji (Sarikei Hospital, Malaysia), Cheah Phee Kheng (Sabah Women and Childrens Hospital, Malaysia), Shamila bt Mohamad Ali (Ampang Hospital, Malaysia), Periyanayaki Ramanathan (Kajang Hospital, Malaysia), Chia Boon Yang (Miri Hospital, Malaysia), Hon Woei Chia (Sarawak General Hospital, Malaysia), Hafidahwati binti Hamad (Queen Elizabeth II Hospital, Malaysia), Samsu Ambia Ismail (Teluk Intan Hospital, Malaysia), Wan Rasydan B. Wan Abdullah (Raja Perempuan Zainab II Hospital, Malaysia), Hideharu Tanaka (Kokushikan University, Japan), Akio Kimura (National Center for Global Health and Medicine Hospital, Japan), Bernadett Velasco (East Avenue Medical Center, Philippines), Carlos D. Gundran (Philippine College of Emergency Medicine, Philippines), Pauline Convocar (Southern Philippines Medical Centre, Philippines), Nerissa G.Sabarre (Pasig City General Hospital, Philippines), Patrick Joseph Tiglao (Corazon Locsin Montelibano Memorial Regional Hospital, Philippines), Ki Jeong Hong (Seoul National Univerisity Hospital, South Korea), Kyoung Jun Song (Boramae Medical Center, South Korea), Joo Jeong (Seoul National Univerisity Bundang Hospital, South Korea), Sung Woo Moon and Joo-yeong Kim (Korea University Ansan Hospital, South Korea), Won Chul Cha (Samsung Medical Center, South Korea), Seung Chul Lee (Dongguk University Ilsan Hospital, South Korea), Jae Yun Ahn (Kyungpook National University Hospital, South Korea), Kang Hyeon Lee (Wonju Severance Christian Hospital, South Korea), Seok Ran Yeom (Pusan National University Hospital, South Korea), Hyeon Ho Ryu (Chonnam National University Hospital, South Korea), Su Jin Kim (Korea University Anam Hospital, South Korea), Sang Chul Kim (Chungbuk National University Hospital, South Korea), Lin-Chen Chiang (National Taiwan University Hospital, Taiwan), Jen Tang Sun (Far Eastern Memorial Hospital, Taiwan), Ruei-Fang Wang (Shin Kong Wu Ho-Su Memorial Hospital, Taiwan), Shang-Lin Hsieh (Mackay Memorial Hospital, Taiwan), Wei-Fong Kao (Taipei City Hospital, Taiwan), Sattha Riyapan (Faculty of Medicine Siriraj Hospital, Thailand), Parinya Tianwibool (Faculty of Medicine Chiangmai University, Thailand), Phudit Buaprasert (Faculty of medicine Vajira hospital, Navamindradhiraj University, Thailand), Osaree Akaraborworn (Prince of Songkla University, Thailand), Omer Ahmed Al Sakaf (Dubai Coorporation for Ambulance Services, United Arab Emirates), Saleh Fares LLC (National Ambulance, United Arab Emirates), Le Bao Huy (Thong Nhat Hospital, Vietnam), Do Ngoc Son (Bach Mai Hospital, Vietnam), Nguyen Van Dai (Viet Tiep Hospital, Vietnam).


This research received no external funding.

Author information

Authors and Affiliations




T-HC, S-LH and W-CC conceived the study, designed the trial. S-LH, WT, D-KC and W-HC supervised the conduct of the trial and data collection. W-CC, SDS, SFJ, DNS, KJH and J-TS undertook recruitment of participating centers and patients and managed the data, including quality control. C-HH provided statistical advice on study design and analyzed the data. T-HC, C-HH, W-CC and S-LH drafted the manuscript, and all authors contributed substantially to its revision. T-HC takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Tse-Hao Chen.

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Conflict of interest

There are no conflicts of interest to declare.

Ethics approval

The design and execution of this retrospective study was approved by the Institutional Review Board of MacKay Memorial Hospital (21MMHIS032e).

Consent to participate

Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous clinical data.

Consent for publication

All authors have read and approved the final manuscript.

Additional information

The members of the PATOS Clinical Research Network are listed in acknowledgements.

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Hsieh, SL., Hsiao, CH., Chiang, WC. et al. Association between the time to definitive care and trauma patient outcomes: every minute in the golden hour matters. Eur J Trauma Emerg Surg 48, 2709–2716 (2022).

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