The impact of prehospital time intervals on mortality in moderately and severely injured patients

Job F Waalwijk; Rogier van der Sluijs; Robin D Lokerman; Audrey A A Fiddelers; Falco Hietbrink; Luke P H Leenen; Martijn Poeze; Mark van Heijl; Pre-hospital Trauma Triage Research Collaborative

doi:10.1097/TA.0000000000003380

The impact of prehospital time intervals on mortality in moderately and severely injured patients

Job F Waalwijk^*, Rogier van der Sluijs, Robin D Lokerman, Audrey A A Fiddelers, Falco Hietbrink, Luke P H Leenen, Martijn Poeze, Mark van Heijl, Pre-hospital Trauma Triage Research Collaborative

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: 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 was to investigate the association between prehospital time and mortality.

METHODS: All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) that 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 h 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.

RESULTS: We included 22,525 moderately and severely injured patients. 24 h and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24 h (relative risk [RR] 1.029; 95% CI, 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 h (RR 1.797; 1.406-2.296) and 30-day mortality (RR 1.298; 1.180-1.428). Total prehospital (24 h: RR 0.998; 0.990-1.007; 30-day: RR 1.000, 0.997-1.004) and transport (24 h: RR 0.996; 0.982-1.010; 30-day: RR 0.995; 0.989-1.001) time were not associated with mortality.

CONCLUSIONS: 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. Additionally, transport time was found not to be associated with mortality.

LEVEL OF EVIDENCE: Prognostic study, level III.

Original language	English
Pages (from-to)	520-527
Number of pages	8
Journal	Journal of Trauma and Acute Care Surgery
Volume	92
Issue number	3
Early online date	16 Aug 2021
DOIs	https://doi.org/10.1097/TA.0000000000003380
Publication status	Published - Mar 2022

Keywords

ACCURACY
EMERGENCY MEDICAL-SERVICES
GOLDEN HOUR
LEVEL
OF-HOSPITAL TIME
PROPENSITY SCORE
SCENE
SURVIVAL
TRAUMA-CENTER CARE
TRIAGE
Trauma
emergency medical services
mortality
prehospital
time

Access to Document

10.1097/TA.0000000000003380

Cite this

Waalwijk, J. F., van der Sluijs, R., Lokerman, R. D., Fiddelers, A. A. A., Hietbrink, F., Leenen, L. P. H., Poeze, M., van Heijl, M., & Pre-hospital Trauma Triage Research Collaborative (2022). The impact of prehospital time intervals on mortality in moderately and severely injured patients. Journal of Trauma and Acute Care Surgery, 92(3), 520-527. https://doi.org/10.1097/TA.0000000000003380

@article{a404db48e9764f549f9013af2e98ba7f,

title = "The impact of prehospital time intervals on mortality in moderately and severely injured patients",

abstract = "BACKGROUND: 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 was to investigate the association between prehospital time and mortality.METHODS: All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) that 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 h 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.RESULTS: We included 22,525 moderately and severely injured patients. 24 h and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24 h (relative risk [RR] 1.029; 95% CI, 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 h (RR 1.797; 1.406-2.296) and 30-day mortality (RR 1.298; 1.180-1.428). Total prehospital (24 h: RR 0.998; 0.990-1.007; 30-day: RR 1.000, 0.997-1.004) and transport (24 h: RR 0.996; 0.982-1.010; 30-day: RR 0.995; 0.989-1.001) time were not associated with mortality.CONCLUSIONS: 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. Additionally, transport time was found not to be associated with mortality.LEVEL OF EVIDENCE: Prognostic study, level III.",

keywords = "ACCURACY, EMERGENCY MEDICAL-SERVICES, GOLDEN HOUR, LEVEL, OF-HOSPITAL TIME, PROPENSITY SCORE, SCENE, SURVIVAL, TRAUMA-CENTER CARE, TRIAGE, Trauma, emergency medical services, mortality, prehospital, time",

author = "Waalwijk, {Job F} and {van der Sluijs}, Rogier and Lokerman, {Robin D} and Fiddelers, {Audrey A A} and Falco Hietbrink and Leenen, {Luke P H} and Martijn Poeze and {van Heijl}, Mark and {Pre-hospital Trauma Triage Research Collaborative}",

note = "Copyright {\textcopyright} 2021 Lippincott Williams & Wilkins, Inc.",

year = "2022",

month = mar,

doi = "10.1097/TA.0000000000003380",

language = "English",

volume = "92",

pages = "520--527",

journal = "Journal of Trauma and Acute Care Surgery",

issn = "2163-0755",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "3",

}

Waalwijk, JF, van der Sluijs, R, Lokerman, RD, Fiddelers, AAA, Hietbrink, F, Leenen, LPH, Poeze, M, van Heijl, M & Pre-hospital Trauma Triage Research Collaborative 2022, 'The impact of prehospital time intervals on mortality in moderately and severely injured patients', Journal of Trauma and Acute Care Surgery, vol. 92, no. 3, pp. 520-527. https://doi.org/10.1097/TA.0000000000003380

TY - JOUR

T1 - The impact of prehospital time intervals on mortality in moderately and severely injured patients

AU - Waalwijk, Job F

AU - van der Sluijs, Rogier

AU - Lokerman, Robin D

AU - Fiddelers, Audrey A A

AU - Hietbrink, Falco

AU - Leenen, Luke P H

AU - Poeze, Martijn

AU - van Heijl, Mark

AU - Pre-hospital Trauma Triage Research Collaborative

PY - 2022/3

Y1 - 2022/3

N2 - BACKGROUND: 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 was to investigate the association between prehospital time and mortality.METHODS: All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) that 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 h 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.RESULTS: We included 22,525 moderately and severely injured patients. 24 h and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24 h (relative risk [RR] 1.029; 95% CI, 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 h (RR 1.797; 1.406-2.296) and 30-day mortality (RR 1.298; 1.180-1.428). Total prehospital (24 h: RR 0.998; 0.990-1.007; 30-day: RR 1.000, 0.997-1.004) and transport (24 h: RR 0.996; 0.982-1.010; 30-day: RR 0.995; 0.989-1.001) time were not associated with mortality.CONCLUSIONS: 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. Additionally, transport time was found not to be associated with mortality.LEVEL OF EVIDENCE: Prognostic study, level III.

AB - BACKGROUND: 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 was to investigate the association between prehospital time and mortality.METHODS: All moderately and severely injured trauma patients (i.e., patients with an Injury Severity Score of 9 or greater) that 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 h 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.RESULTS: We included 22,525 moderately and severely injured patients. 24 h and 30-day mortality were 1.3% and 7.3%, respectively. On-scene time per minute was significantly associated with 24 h (relative risk [RR] 1.029; 95% CI, 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 h (RR 1.797; 1.406-2.296) and 30-day mortality (RR 1.298; 1.180-1.428). Total prehospital (24 h: RR 0.998; 0.990-1.007; 30-day: RR 1.000, 0.997-1.004) and transport (24 h: RR 0.996; 0.982-1.010; 30-day: RR 0.995; 0.989-1.001) time were not associated with mortality.CONCLUSIONS: 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. Additionally, transport time was found not to be associated with mortality.LEVEL OF EVIDENCE: Prognostic study, level III.

KW - ACCURACY

KW - EMERGENCY MEDICAL-SERVICES

KW - GOLDEN HOUR

KW - LEVEL

KW - OF-HOSPITAL TIME

KW - PROPENSITY SCORE

KW - SCENE

KW - SURVIVAL

KW - TRAUMA-CENTER CARE

KW - TRIAGE

KW - Trauma

KW - emergency medical services

KW - mortality

KW - prehospital

KW - time

U2 - 10.1097/TA.0000000000003380

DO - 10.1097/TA.0000000000003380

M3 - Article

C2 - 34407005

SN - 2163-0755

VL - 92

SP - 520

EP - 527

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 3

ER -