Pre-hospital trauma care: a proposal for more efficient evaluation.

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Pre-hospital Care Research

Background:

• Mortality is a key outcome in pre-hospital trauma care but is affected by numerous factors beyond the care provided.
• Assessing pre-hospital trauma care effectiveness requires reliable and sensitive outcome parameters.

Purpose of the Study:

• To evaluate the change in probability of survival (Ps) using the TRISS methodology as an alternative outcome parameter for pre-hospital trauma care.
• To compare the sample size requirements for detecting a hypothetical mortality reduction versus a change in Ps.

Main Methods:

• Calculated the change in Ps before and after pre-hospital trauma care using the TRISS methodology.
• Assessed correlations between patient characteristics and changes in Ps.
• Determined sample size needed to detect a 3% mortality reduction versus a change in Ps.

Main Results:

• In 191 patients (Injury Severity Score >= 16), Ps did not change in 140, increased in 36, and decreased in 15.
• Significant differences in Revised Trauma Score and age were observed between groups with differing Ps changes.
• Detecting a 3% mortality reduction requires 6800 patients, compared to 3500 patients when using change in Ps.

Conclusions:

• Change in Ps is a more efficient outcome parameter for evaluating pre-hospital trauma care.
• Reliable data registration through collaboration between ambulance services and trauma centers is crucial for accurate assessment.