Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea.
Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea.
Injury. 2024 May;55(5):111437. doi: 10.1016/j.injury.2024.111437. Epub 2024 Feb 15.
It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma.
This retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea. We developed a prehospital ROSC prediction model to categorize EMS agencies into quartiles (Q1-Q4) based on the observed-to-expected (O/E) ROSC ratio for each EMS agency. We evaluated the national EMS protocol compliance of on-scene management according to O/E ROSC ratio quartile. The association between O/E ROSC ratio quartiles and trauma-related early mortality was determined in a multi-level logistic regression model by adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI).
Among 30,034 severe trauma patients, 4,836 were analyzed. Patients in Q4 showed the lowest early mortality rate (5.6 %, 5.5 %, 4.8 %, and 3.4 % in Q1, Q2, Q3, and Q4, respectively). In groups Q1 to Q4, increasing compliance with the national EMS on-scene management protocol (trauma center transport, basic airway management for patients with altered mentality, spinal motion restriction for patients with spinal injury, and intravenous access for patients with hypotension) was observed (p for trend <0.05). Multivariable multi-level logistic regression analysis showed significantly lower early mortality in Q4 than in Q1 (adjusted OR [95 % CI] 0.56 [0.35-0.91]).
Major trauma patients managed by EMS agencies with high success rates in achieving prehospital ROSC in non-traumatic OHCA were more likely to receive protocol-based care and exhibited lower early mortality.
目前尚不清楚在院外心脏骤停(OHCA)质量指标表现良好的紧急医疗服务(EMS)机构在治疗其他紧急情况方面是否表现同样出色。我们旨在评估 EMS 机构非创伤性 OHCA 质量指标与院前管理流程和主要创伤临床结局之间的关联。
本回顾性队列研究分析了来自韩国全国范围内基于人群的 OHCA(2017 年至 2018 年成人 EMS 治疗的非创伤性 OHCA 患者)和主要创伤(2018 年成人、EMS 治疗和损伤严重程度评分≥16 的创伤患者)登记处的数据。我们开发了一个院前 ROSC 预测模型,根据每个 EMS 机构的观察到的与预期的 ROSC 比值(O/E)将 EMS 机构分为四组(Q1-Q4)。我们根据 O/E ROSC 比值四分位数评估现场管理的国家 EMS 方案依从性。通过调整后的优势比(OR)和 95 %置信区间(95 %CI),在多水平逻辑回归模型中确定 O/E ROSC 比值四分位数与创伤相关早期死亡率之间的关联。
在 30034 例严重创伤患者中,有 4836 例进行了分析。Q4 组的早期死亡率最低(Q1、Q2、Q3 和 Q4 组分别为 5.6%、5.5%、4.8%和 3.4%)。在 Q1 至 Q4 组中,观察到国家 EMS 现场管理方案(创伤中心转运、神志改变患者基本气道管理、脊柱损伤患者脊柱运动限制、低血压患者静脉通路)的依从性不断提高(趋势 p<0.05)。多变量多层次逻辑回归分析显示,Q4 组的早期死亡率明显低于 Q1 组(调整后的 OR [95 %CI] 0.56 [0.35-0.91])。
在非创伤性 OHCA 中成功实现院前 ROSC 率较高的 EMS 机构管理的主要创伤患者更有可能接受基于方案的治疗,并且早期死亡率较低。