Association of Prehospital Time to In-Hospital Trauma Mortality in a Physician-Staffed Emergency Medicine System

被引：151

作者：

Gauss, Tobias ^{[1
]}

Ageron, Francois-Xavier ^{[2
]}

Devaud, Marie-Laure ^{[3
]}

Debaty, Guillaume ^{[4
]}

Travers, Stephane ^{[5
]}

Garrigue, Delphine ^{[6
]}

Raux, Mathieu ^{[7
,8
]}

Harrois, Anatole ^{[9
]}

Bouzat, Pierre ^{[10
]}

Abback, Paer ^{[11
]}

Attias, Arie ^{[12
]}

Ausset, Sylvain ^{[13
]}

Boutonnet, Mathieu ^{[14
]}

Cook, Fabrice ^{[15
]}

Dhonneur, Gilles ^{[16
,17
]}

Duranteau, Jacques ^{[18
,19
]}

Hamada, Sophie ^{[20
]}

Langeron, Olivier ^{[21
]}

Paugam-Burtz, Catherine ^{[22
,23
]}

Pirracchio, Romain ^{[24
,25
]}

Riou, Bruno ^{[26
,27
]}

de St Maurice, Guillaume ^{[28
]}

Vigue, Bernard ^{[29
]}

Albasini, Francois ^{[30
]}

Champly, Frederic ^{[31
]}

Chapiteau, Laurent ^{[32
]}

Haller, Etienne ^{[33
]}

Hoareau, Christophe ^{[34
]}

Levrat, Albrice ^{[35
]}

Rancurel, Elisabeth ^{[36
]}

Savary, Dominique ^{[37
]}

Thouret, Jean-Marc ^{[38
]}

Useglio, Pascal ^{[39
]}

Vallenet, Claire ^{[40
]}

Venchiarutti, Damien ^{[41
]}

Chollet-Xemard, Charlotte ^{[42
]}

Michelland, Laurianne ^{[43
]}

Reuter, Paul-Georges ^{[44
]}

Ricard-Hibon, Agnes ^{[45
]}

Richard, Olivier ^{[46
]}

Sapir, David ^{[47
]}

Vivien, Benoit ^{[48
]}

Bobbia, Xavier ^{[49
]}

Jouffroy, Romain ^{[50
]}

Lanot, Pierre ^{[51
]}

Roger, Claire ^{[52
]}

Lamblin, Antoine ^{[53
]}

Bouhours, Guillaume ^{[54
]}

Pasquier, Pierre ^{[54
]}

Prunet, Bertand ^{[55
]}

机构：

[1] Hop Univ Paris Nord Val de Seine, Hop Beaujon, Assistance Publ Hop Paris, Dept Anesthesia & Crit Care, 100 Blvd Gen Leclerc, F-92110 Clichy, France

[2] Hosp Annecy Genevois, Trauma Syst Northern French Alps Emergency Networ, Annecy, France

[3] Ctr Hosp Rene Dubos, Prehosp Emergency Med Serv, Serv Aide Med Urgente 95, Pontoise, France

[4] Univ Hosp Grenoble Alps, Serv Aide Med Urgente 38, Dept Emergency Med, Grenoble, France

[5] French Mil Hlth Serv, Paris Fire Brigade Emergency Med Dept, Paris, France

[6] Univ Hosp, Dept Anesthesia & Crit Care, Interdisciplinary Emergency Platform, Lille, France

[7] Sorbonne Univ, Trust Pitie Salpetriere, Assistance Publ Hop Paris, Dept Anesthesia & Crit Care, Paris, France

[8] INSERM, Unite Mixte Rech Sci 1158 Clin & Expt Resp Neurop, Paris, France

[9] Univ Paris Saclay, Univ Paris Sud, Bicetre Univ Hosp Paris Sud, Assistance Publ Hop Paris,Dept Anesthesiol & Crit, Le Kremlin Bicetre, France

[10] Univ Hosp, Dept Anesthesia & Crit Care, Grenoble, France

[11] Hop Univ Paris Nord Val de Seine, Beaujon Univ Hosp, Clichy Assistance Publ Hop Paris AP HP, Clichy, France

[12] Hop Henri Mondor, AP HP, Dept Anesthesiol & Crit Care, Creteil, France

[13] Hop Interarmees Percy, Anesthesiol & Crit Care, Clamart, France

[14] Hop Interarmees Percy, Anesthesiol & Crit Care, Clamart, France

[15] Hop Henri Mondor, AP HP, Dept Anesthesiol & Crit Care, Creteil, France

[16] Univ Paris Est, Creteil, France

[17] Hop Henri Mondor, AP HP, Dept Anesthesiol & Crit Care, Creteil, France

[18] Univ Paris Sud, Le Kremlin Bicetre, France

[19] Hop Univ Paris Sud, Hop Bicetre, AP HP, Dept Anesthesiol & Crit Care, Le Kremlin Bicetre, France

[20] Hop Univ Paris Sud, Hop Bicetre, AP HP, Dept Anesthesiol & Crit Care, Le Kremlin Bicetre, France

[21] Hop Henri Mondor, AP HP, Dept Anesthesiol & Crit Care, Creteil, France

[22] Univ Paris 07, Clichy, France

[23] Hop Univ Paris Nord Val De Seine, Beaujon Univ Hosp, AP HP, Dept Anesthesiol & Crit Care, Clichy, France

[24] Univ Paris 05, Paris, France

[25] Hop Europeen Georges Pompidou, AP HP, Dept Anesthesiol & Crit Care, Paris, France

[26] Sorbonne Univ, Unite Mixte Rech Sci 1166, Paris, France

[27] Grp Hosp Pitie Salpetriere Charles Foix, AP HP, Dept Emergency Med, Paris, France

[28] Hop Interarmees Percy, Anesthesiol & Crit Care, Clamart, France

[29] Hop Univ Paris Sud, Hop Bicetre, AP HP, Dept Anesthesiol & Crit Care, La Kremlin Bicetre, France

[30] St Jean de Maurienne Hosp, Emergency Med Serv, St Jean De Maurienne, France

[31] Hop Mt Blanc, Dept Emergency Med, Sallanches, France

[32] Albertville Hosp, Emergency Med Serv, Albertville, France

[33] St Jean de Maurienne Hosp, Emergency Med Serv, St Jean De Maurienne, France

[34] Bourg St Maurice Hosp, Emergency Med Serv, Bourg St Maurice, France

[35] Annecy Hosp, Intens Care Unit, Annecy, France

[36] Grenoble Univ Hosp, Hop Albert Michallon, Emergency Med Serv, Grenoble, France

[37] Annecy Hosp, Emergency Med Serv, Annecy, France

[38] Chambery Hosp, Intens Care Med, Chambery, France

[39] Chambery Hosp, Emergency Med Serv, Chambery, France

[40] Ctr Hosp Alpes Leman, Emergency Med Serv, Annemasse, France

[41] Emergency Med Serv, Albertville, France

[42] Hop Henri Mondor, AP HP, SAMU 94, Creteil, France

[43] AP HP, SAMU 93, Bobigny, France

[44] AP HP, SAMU 92, Garches, France

[45] SAMU 95, Val Doise, Pontoise, France

[46] SAMU 78, Versailles, France

[47] SAMU 91, Lessonne, Corbeil, France

[48] AP HP, SAMU 75, Paris, France

[49] CHU Nimes, Emergency Med, Nimes, France

[50] Hop Necker Enfants Malad, AP HP, Anesthesiol & Crit Care, Paris, France

来源：

JAMA SURGERY | 2019年 / 154卷 / 12期

关键词：

GOLDEN HOUR; SCENE TIME; IMPACT; GERMANY; INJURY; LEVEL; SHOCK; CARE;

D O I：

10.1001/jamasurg.2019.3475

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Importance The association between total prehospital time and mortality in physician-staffed trauma systems remains uncertain. Objective To describe the association of total prehospital time and in-hospital mortality in prehospital, physician-staffed trauma systems in France, with the hypothesis that total prehospital time is associated with increased mortality. Design, Setting, and Participants This cohort study was conducted from January 2009 to December 2016. Data for this study were derived from 2 distinct regional trauma registries in France (1 urban and 1 rural) that both have a physician-staffed emergency medical service. Consecutive adult trauma patients admitted to either of the regional trauma referral centers during the study period were included. Data analysis took place from March 2018 to September 2018. Main Outcomes and Measures The association between death and prehospital time was assessed with a multivariable model adjusted with confounders. Total prehospital time was the primary exposure variable, recorded as the time from the arrival of the physician-led prehospital care team on scene to the arrival at the hospital. The main outcome of interest was all-cause in-hospital mortality. Results A total of 10216 patients were included (mean [SD] age, 41 [18] years; 7937 men [78.3%]) affected by predominantly nonpenetrating injuries (9265 [91.5%]), with a mean (SD) Injury Severity Score of 17 (14) points. Of the patients, 6737 (66.5%) had at least 1 body region with an Abbreviated Injury Scale score of 3 or more. A total of 1259 patients (12.4%) presented in shock (with systolic pressure <90 mm Hg) and 2724 (26.9%) with severe head injury (Abbreviated Injury Scale score >= 3 points). On unadjusted analysis, increasing prehospital times (in 30-minute categories) were associated with a markedly and constant increase in the risk of in-hospital death. The odds of death increased by 9% for each 10-minute increase in prehospital time (odds ratio, 1.09 [95% CI, 1.07-1.11]) and after adjustment by 4% (odds ratio, 1.04 [95% CI, 1.01-1.07]). Conclusions and Relevance In this study, an increase in total prehospital time was associated with increasing in-hospital all-cause mortality in trauma patients at a physician-staffed emergency medical system, after adjustment for case complexity. Prehospital time is a management objective in analogy to physiological targets. These findings plead for a further streamlining of prehospital trauma care and the need to define the optimal intervention-to-time ratio. This cohort study assesses the association of total prehospital time and in-hospital mortality in 2 prehospital, physician-staffed emergency medical systems in urban and rural France. Question How are prehospital time and mortality associated in a physician-staffed trauma system? Findings The results of this cohort study from 2 French trauma registries demonstrate a linear association between total prehospital time and in-hospital all-cause mortality. The odds of death increased by 8% for each 10-minute increase in prehospital time. Meaning These findings call for a further streamlining of prehospital trauma care and the need to define the optimal intervention-to-time ratio.

引用

页码：1117 / 1124

页数：8

共 30 条

[1] Time is the enemy: Mortality in trauma patients with hemorrhage from torso injury occurs long before the "golden hour" [J].