From the Department of Surgery (J.F.W., R.D.L., F.H., L.P.H.L., M.v.H.), University Medical Center Utrecht, Utrecht; Department of Surgery (J.F.W., M.P.), Maastricht University Medical Center; Network Acute Care Limburg (J.F.W., A.A.A.F., M.P.), Maastricht University Medical Center, Maastricht, the Netherlands; Center for Artificial Intelligence in Medicine and Imaging (R.v.d.S.), Stanford University, Stanford; and Department of Surgery (M.v.H.), Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, the Netherlands.
J Trauma Acute Care Surg. 2022 Mar 1;92(3):520-527. doi: 10.1097/TA.0000000000003380.
Modern trauma systems and emergency medical services aim to reduce prehospital time intervals to achieve optimal outcomes. However, current literature remains inconclusive on the relationship between time to definitive treatment and mortality. The aim of this study was to investigate the association between prehospital time and mortality.
All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) who were transported from the scene of injury to a trauma center by ground ambulances of the participating emergency medical services between 2015 and 2017 were included. Exposures of interest were total prehospital time, on-scene time, and transport time. Outcomes were 24-hour and 30-day mortality. Generalized linear models including inverse probability weights for several potential confounders were constructed. A generalized additive model was constructed to enable visual inspection of the association.
We included 22,525 moderately and severely injured patients. Twenty-four-hour and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24-hour (relative risk [RR], 1.029; 95% confidence interval, 1.018-1.040) and 30-day mortality (RR, 1.013; 1.008-1.017). We found that this association was also present in patients with severe injuries, traumatic brain injury, severe abdominal injury, and stab or gunshot wound. An on-scene time of 20 minutes or longer demonstrated a strong association with 24-hour (RR, 1.797; 1.406-2.296) and 30-day mortality (RR, 1.298; 1.180-1.428). Total prehospital (24-hour: RR, 0.998; 0.990-1.007; 30-day: RR, 1.000, 0.997-1.004) and transport (24-hour: RR, 0.996; 0.982-1.010; 30-day: RR, 0.995; 0.989-1.001) time were not associated with mortality.
A prolonged on-scene time is associated with mortality in moderately and severely injured patients, which suggests that a reduced on-scene time may be favorable for these patients. In addition, transport time was found not to be associated with mortality.
Prognostic and Epidemiologic; level III.
现代创伤系统和急诊医疗服务旨在减少院前时间间隔，以实现最佳结果。然而，目前的文献对于到达确定性治疗的时间与死亡率之间的关系仍存在争议。本研究旨在探讨院前时间与死亡率之间的关系。
本研究纳入了 2015 年至 2017 年间，由参与的急救医疗服务机构的地面救护车从创伤现场转运至创伤中心的中度和重度创伤患者（即损伤严重度评分[ISS]为 9 或更高的患者）。感兴趣的暴露因素包括总院前时间、现场时间和转运时间。结局为 24 小时和 30 天死亡率。构建了包含几个潜在混杂因素的逆概率加权广义线性模型。构建了广义加性模型，以实现对关联的直观检查。
我们纳入了 22525 例中度和重度创伤患者。24 小时和 30 天死亡率分别为 1.3%和 7.3%。现场时间每分钟与 24 小时（相对风险[RR]，1.029；95%置信区间[CI]，1.018-1.040）和 30 天死亡率（RR，1.013；95%CI，1.008-1.017）显著相关。我们发现，这种关联在严重损伤、创伤性脑损伤、严重腹部损伤以及刺伤或枪击伤患者中也存在。现场时间达到 20 分钟或更长时间与 24 小时（RR，1.797；95%CI，1.406-2.296）和 30 天死亡率（RR，1.298；95%CI，1.180-1.428）有很强的关联。总院前时间（24 小时：RR，0.998；95%CI，0.990-1.007；30 天：RR，1.000；95%CI，0.997-1.004）和转运时间（24 小时：RR，0.996；95%CI，0.982-1.010；30 天：RR，0.995；95%CI，0.989-1.001）与死亡率无关。
现场时间延长与中度和重度创伤患者的死亡率相关，这表明减少现场时间可能对这些患者有利。此外，转运时间与死亡率无关。
预后和流行病学；III 级。
