The OPALS major trauma Study: impact of advanced life-support on survival and morbidity

被引：206
作者：
Stiell, Ian G. [1 ,3 ]
Nesbitt, Lisa P. [3 ]
Pickett, William [4 ]
Munkley, Douglas [5 ]
Spaite, Daniel W. [6 ]
Banek, Jane [3 ]
Field, Brian [7 ]
Luinstra-Toohey, Lorraine [5 ]
Maloney, Justin [8 ]
Dreyer, Jon [9 ]
Lyver, Marion [10 ]
Campeau, Tony [11 ]
Wells, George A. [2 ,3 ]
机构：
[1] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada
[2] Univ Ottawa, Dept Epidemiol & Community Hlth, Ottawa, ON, Canada
[3] Ottawa Hlth Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada
[4] Queens Univ, Dept Emergency Med, Kingston, ON, Canada
[5] Greater Niagara Base Hosp, Niagara Falls, ON, Canada
[6] Univ Arizona, Dept Emergency Med, Tucson, AZ USA
[7] Interdev Technol, Toronto, ON, Canada
[8] Ottawa Base Hosp Program, Ottawa, ON, Canada
[9] Univ Western Ontario, Div Emergency Med, London, ON, Canada
[10] McMaster Univ, Dept Family Med, Hamilton, ON L8S 4L8, Canada
[11] Ontario Minist Hlth & Long Term Care, Emergency Hlth Serv Campeau, Toronto, ON, Canada
来源：
CANADIAN MEDICAL ASSOCIATION JOURNAL | 2008年 / 178卷 / 09期
关键词：
D O I：
10.1503/cmaj.071154
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background: To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established Methods: The Ontario Prehospital Advanced Life Support ( OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase ( during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results: Among the 2867 patients enrolled in the basic life-support (n= 1373) and advanced life-support ( n= 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score ( 24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p=0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p= 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p= 0.16). Interpretation: The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.
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收藏
页码：1141 / 1152
页数：12
相关论文
共 40 条
[31]   Prehospital advanced life support for major trauma: Critical need for clinical trials [J].
Spaite, D ;
Criss, EA ;
Valenzuela, TD ;
Meislin, HW .
ANNALS OF EMERGENCY MEDICINE, 1998, 32 (04) :480-489
[32]   Out-of-hospital rapid sequence intubation: Are we helping or hurting our patients? [J].
Spaite, DW ;
Criss, EA .
ANNALS OF EMERGENCY MEDICINE, 2003, 42 (06) :729-730
[33]   THE IMPACT OF INJURY SEVERITY AND PREHOSPITAL PROCEDURES ON SCENE TIME IN VICTIMS OF MAJOR TRAUMA [J].
SPAITE, DW ;
TSE, DJ ;
VALENZUELA, TD ;
CRISS, EA ;
MEISLIN, HW ;
MAHONEY, M ;
ROSS, J .
ANNALS OF EMERGENCY MEDICINE, 1991, 20 (12) :1299-1305
[34]   Advanced life support for out-of-hospital respiratory distress [J].
Stiell, Ian G. ;
Spaite, Daniel W. ;
Field, Brian ;
Nesbitt, Lisa P. ;
Munkley, Doug ;
Maloney, Justin ;
Dreyer, Jon ;
Toohey, Lorraine Luinstra ;
Campeau, Tony ;
Dagnone, Eugene ;
Lyver, Marion ;
Wells, George A. ;
Stempien, M. W. ;
Parkinson, C. I. ;
Waldbillig, D. ;
Ballah, K. W. ;
Jones, G. J. ;
Halladay, M. R. ;
Dreyer, J. F. ;
Boyle, K. A. ;
Munkley, D. P. ;
Toohey, L. G. Luinstra ;
Maloney, J. P. ;
Trickett, J. P. ;
Arcieri, V. ;
Fader, J. W. ;
Lees, M. G. J. ;
LaBarre, D. D. ;
Lepage, R. S. ;
Michaud, S. ;
Affleck, A. W. ;
Tyson, T. A. ;
Fedoruk, J. C. ;
Gobet, M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (21) :2156-2164
[35]   Advanced cardiac life support in out-of-hospital cardiac arrest. [J].
Stiell, IG ;
Wells, GA ;
Field, B ;
Spaite, DW ;
Nesbitt, LP ;
De Maio, VJ ;
Nichol, G ;
Cousineau, D ;
Blackburn, J ;
Munkley, D ;
Luinstra-Toohey, L ;
Campeau, T ;
Dagnone, E ;
Lyver, M .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (07) :647-656
[36]   The Ontario Prehospital Advanced Life Support (OPALS) Study Part II: Rationale and methodology for trauma and respiratory distress patients [J].
Stiell, IG ;
Wells, GA ;
Spaite, DW ;
Nichol, G ;
O'Brien, B ;
Munkley, DP ;
Field, BJ ;
Lyver, MB ;
Luinstra, LG ;
Dagnone, E ;
Campeau, T ;
Ward, R ;
Anderson, S .
ANNALS OF EMERGENCY MEDICINE, 1999, 34 (02) :256-262
[37]   The functional independence measure: Tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories [J].
Stineman, MG ;
Shea, JA ;
Jette, A ;
Tassoni, CJ ;
Ottenbacher, KJ ;
Fiedler, R ;
Granger, CV .
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 1996, 77 (11) :1101-1108
[38]   Out-of-hospital endotracheal intubation and outcome after traumatic brain injury [J].
Wang, HE ;
Peitzman, AB ;
Cassidy, LD ;
Adelson, PD ;
Yealy, DM .
ANNALS OF EMERGENCY MEDICINE, 2004, 44 (05) :439-450
[39]  
Winchell RJ, 1997, ARCH SURG-CHICAGO, V132, P592
[40]   Out-of-hospital endotracheal intubation in traumatic brain injury: Outcomes research provides us with an unexpected outcome [J].
Zink, BJ ;
Maio, RF .
ANNALS OF EMERGENCY MEDICINE, 2004, 44 (05) :451-453
1234