Al-Thani Hassan, Mekkodathil Ahammed, Hertelendy Attila J, Frazier Tim, Ciottone Gregory R, El-Menyar Ayman
Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.
Department of Decision Sciences and Business Analytics, College of Business, Florida International University, Miami, USA.
Prehosp Disaster Med. 2020 Oct;35(5):508-515. doi: 10.1017/S1049023X20000904. Epub 2020 Jul 17.
The increase in mortality and total prehospital time (TPT) seen in Qatar appear to be realistic. However, existing reports on the influence of TPT on mortality in trauma patients are conflicting. This study aimed to explore the impact of prehospital time on the in-hospital outcomes.
A retrospective analysis of data on patients transferred alive by Emergency Medical Services (EMS) and admitted to Hamad Trauma Center (HTC) of Hamad General Hospital (HGH; Doha, Qatar) from June 2017 through May 2018 was conducted. This study was centered on the National Trauma Registry database. Patients were categorized based on the trauma triage activation and prehospital intervals, and comparative analysis was performed.
A total of 1,455 patients were included, of which nearly one-quarter of patients required urgent and life-saving care at a trauma center (T1 activations). The overall TPT was 70 minutes and the on-scene time (OST) was 24 minutes. When compared to T2 activations, T1 patients were more likely to have been involved in road traffic injuries (RTIs); experienced head and chest injuries; presented with higher Injury Severity Score (ISS: median = 22); and had prolonged OST (27 minutes) and reduced TPT (65 minutes; P = .001). Prolonged OST was found to be associated with higher mortality in T1 patients, whereas TPT was not associated.
In-hospital mortality was independent of TPT but associated with longer OST in severely injured patients. The survival benefit may extend beyond the golden hour and may depend on the injury characteristics, prehospital, and in-hospital settings.
卡塔尔死亡率和院前总时间（TPT）的增加似乎是符合实际情况的。然而，现有关于TPT对创伤患者死亡率影响的报告相互矛盾。本研究旨在探讨院前时间对院内结局的影响。
对2017年6月至2018年5月期间由紧急医疗服务（EMS）转运至哈马德总医院（HGH；卡塔尔多哈）哈马德创伤中心（HTC）并存活入院的患者数据进行回顾性分析。本研究以国家创伤登记数据库为核心。根据创伤分诊激活情况和院前间隔对患者进行分类，并进行比较分析。
共纳入1455例患者，其中近四分之一的患者在创伤中心需要紧急和救命治疗（T1激活）。总体TPT为70分钟，现场时间（OST）为24分钟。与T2激活相比，T1患者更有可能遭遇道路交通伤（RTIs）；经历头部和胸部损伤；损伤严重程度评分（ISS：中位数=22）更高；并且OST延长（27分钟）而TPT缩短（65分钟；P = 0.001）。发现OST延长与T1患者较高的死亡率相关，而TPT则无相关性。
院内死亡率与TPT无关，但与重伤患者较长的OST相关。生存获益可能超出黄金救援时间，并且可能取决于损伤特征、院前和院内环境。
