The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma.

Abstract

The benefit of a well organised trauma system is acknowledged but doubts remain concerning the optimal pre-hospital trauma care model. We hypothesise that the treatment of life-threatening events before arrival at trauma centre--either pre-hospital or first hospital--may be more relevant to decreasing mortality than shortening the time to trauma centre. A cohort of 727 trauma patients with life-threatening events--identified as airway, breathing, circulation or neurological disability--requiring transfer to a trauma centre were studied. Data on patient's characteristics, trauma features, and mortality were taken from a trauma registry. Patients were divided into 3 groups depending on the place of treatment of life-threatening events: pre-hospital, first hospital or trauma centre. Survival Kaplan-Meier curves and logistic regression were used to assess the effect of place of treatment of life-threatening events on mortality. Patients from the pre-hospital and first hospital groups had 20% and 27% mortality respectively, compared to 38% among those whose life-threatening events were corrected only at the trauma centre. Logistic regression showed that patients whose life-threatening events were corrected only at the trauma centre had an odds of death 3.3 times greater than those from the pre-hospital group, adjusted for patient and trauma characteristics and time to trauma centre. In trauma patients requiring transfer to a trauma centre, pre-hospital interventions to treat life-threatening events may significantly decrease mortality when compared to similar interventions performed later at the trauma centre.