Abstract
Background
Little evidence exists studying the benefits of pre-hospital trauma team activation. Our study measured the impact of pre-hospital trauma team activation on 24-h survival. Our secondary objectives assessed the effects of pre-hospital trauma team activation on time to emergency procedure, computed tomography, blood transfusion, and critical administration threshold, as well as emergency department length of stay.
Methods
We conducted a 40-month health records review on all trauma team activations at The Ottawa Hospital, a Level 1 Trauma Center. Outcomes were compared between pre-hospital and in-hospital trauma team activations. We used logistic and linear regression models to assess outcomes, while controlling for injury severity score, age, systolic blood pressure, and anti-coagulation use. A P value < 0.05 was considered statistically significant. A sensitivity analysis was also used to validate the primary outcome results.
Results
Of the 1013 trauma team activations occurring during the study period, 762 patients were included. The mean age (41.3 vs. 43.8) and percentage of males (79.4% vs. 77.5%) for pre-hospital activations were similar to their counterparts. Pre-hospital activations did not have a statistically significant effect on 24-h mortality (14.4% vs. 4.5%; P = 0.30). However, pre-hospital activations did demonstrate a statistically significant reduction in time (minutes) to emergency procedure (18.0 vs. 27.0; P < 0.001), computed tomography (37.0 vs 42.0; P = 0.009), and blood transfusion (14.0 vs. 28.0; P < 0.001), as well as emergency department length of stay (101.0 vs. 171.0; P < 0.001).
Conclusion
When controlling for key covariates, pre-hospital trauma team activation did not have a significant effect on 24-h mortality, but did result in a significant reduction in time to emergency procedure, computed tomography, and blood transfusion, as well as emergency department length of stay. Our study demonstrates that pre-hospital trauma team activation can expedite patient intervention and disposition.
Résumé
Contexte
Il existe peu de données sur les avantages de l’activation de l’équipe de traumatologie préhospitalière. Notre étude a mesuré l’impact de l’activation de l’équipe de traumatologie pré-hospitalière sur la survie à 24 heures. Nos objectifs secondaires ont évalué les effets de l’activation de l’équipe de traumatologie préhospitalière sur le délai de la procédure d’urgence, de la tomodensitométrie, de la transfusion sanguine et du seuil d’administration critique, ainsi que sur la durée du séjour dans les services d’urgence.
Méthodes
Nous avons procédé à un examen des dossiers médicaux sur 40 mois pour toutes les activations de l’équipe de traumatologie à l’Hôpital d’Ottawa, un centre de traumatologie de niveau 1. Les résultats ont été comparés entre les activations des équipes de traumatologie pré-hospitalières et intra-hospitalières. Nous avons utilisé des modèles de régression logistique et linéaire pour évaluer les résultats, tout en contrôlant le score de gravité des blessures, l’âge, la pression artérielle systolique et l’utilisation d’anticoagulants. Une valeur P < 0.05 a été considérée comme statistiquement significative. Une analyse de sensibilité a également été utilisée pour valider les résultats primaires.
Résultats
Sur les 1013 activations d’équipes de traumatologie survenues pendant la période de l’étude, 762 patients ont été inclus. L’âge moyen (41.3 contre 43.8) et le pourcentage d’hommes (79.4% contre 77.5%) pour les activations préhospitalières étaient similaires à ceux de leurs homologues. Les activations préhospitalières n’ont pas eu d’effet statistiquement significatif sur la mortalité à 24 heures (14.4% contre 4.5%; P = 0.30). Cependant, les activations préhospitalières ont démontré une réduction statistiquement significative du temps (minutes) nécessaire à la procédure d’urgence (18.0 contre 27.0; P < 0.001), à la tomodensitométrie (37.0 contre 42.0; P = 0.009) et à la transfusion sanguine (14.0 contre 0.009). 28.0; P < 0.001), ainsi que la durée du séjour aux urgences (101.0 contre 171.0; P < 0.001).
Conclusion
En tenant compte des principales covariables, l’activation de l’équipe de traumatologie préhospitalière n’a pas eu d’effet significatif sur la mortalité à 24 heures, mais a entraîné une réduction significative du temps nécessaire à l’intervention d’urgence, à la tomodensitométrie et à la transfusion sanguine, ainsi que de la durée de séjour dans les services d’urgence.
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The authors would like to acknowledge Heather Knight and Angela Marcantonio for their contributions to the project.
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KD: conceptualization, investigation, writing—original draft; MH: conceptualization, supervision, writing—reviewing and editing; ML: conceptualization, writing—reviewing and editing; DG: conceptualization, writing—reviewing and editing; M-JN: methodology, formal analysis, writing—reviewing and editing; JP: conceptualization, methodology, supervision, writing—reviewing and editing.
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Communicated by Ian Stiell.
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Durr, K., Ho, M., Lebreton, M. et al. Evaluating the impact of pre-hospital trauma team activation criteria. Can J Emerg Med 25, 976–983 (2023). https://doi.org/10.1007/s43678-023-00604-0
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DOI: https://doi.org/10.1007/s43678-023-00604-0