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Integrated Compensatory Responses in a Human Model of Hemorrhage
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Prehospital Time Following Traumatic Injury Is Independently Associated With the Need for In-Hospital Blood and Early
Eva V Zadorozny1, Hsing-Hua S Lin1, James Luther1
1Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Air Medical Journal
|December 28, 2023
Summary
Prehospital time and transport mode impact trauma patient outcomes. Helicopter transport is linked to increased early transfusions for severe thoracic injuries, while ground transport shows reduced mortality with longer prehospital times, especially in polytrauma cases.
Area of Science:
- Trauma care and emergency medicine
- Prehospital services and logistics
- Clinical outcomes research
Background:
- Traumatic hemorrhage management is time-critical, with prehospital care influencing in-hospital events.
- Transport modes, including helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS), may affect patient outcomes.
- The relationship between prehospital time and outcomes needs further investigation, particularly considering injury patterns.
Purpose of the Study:
- To investigate the association between prehospital time (on-scene time [OST] and total prehospital time [TPT]) and transport mode with same-day transfusion and mortality.
- To identify specific anatomic injury regions that modify the relationship between prehospital time and outcomes based on transport type.
Main Methods:
- Analysis of an 8-center cohort of adult trauma patients (ISS > 9) from 2017-2022, excluding those with prehospital blood or interfacility transfers.
- Multivariable logistic regression was used to adjust for covariates including prehospital times, transport mode, age, sex, ISS, Glasgow Coma Scale motor score, and field hypotension.
- Outcomes assessed were in-hospital transfusions within 4 hours and 24-hour mortality, stratified by injury patterns and transport mode.
Main Results:
- Transport type significantly modified the association between prehospital time and outcomes.
- HEMS transport showed a positive association between OST/TPT and 4-hour transfusions, while GEMS showed no association.
- Both HEMS and GEMS transport were associated with decreased 24-hour mortality with longer prehospital times. Severe thoracic injuries were linked to increased early transfusions with HEMS OST, and polytrauma with GEMS OST/TPT was linked to decreased 24-hour mortality.
Conclusions:
- Transport mode critically influences the relationship between prehospital time and outcomes like early transfusion and mortality.
- HEMS transport is associated with increased early transfusions, particularly for severe thoracic injuries, while GEMS transport is linked to reduced mortality, especially in polytrauma.
- Understanding these transport-specific effects and injury modifications is crucial for optimizing prehospital trauma care.
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