Emergency medical services time on scene associated with reduced dead-on-arrival status among pediatric patients with severe traumatic brain injury
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View abstract on PubMed
Summary
This summary is machine-generated.Longer emergency medical services (EMS) scene times for pediatric severe traumatic brain injury (TBI) patients were linked to lower odds of being dead on arrival. This suggests on-scene stabilization may improve outcomes, challenging rapid transport assumptions.
Area Of Science
- Pediatric emergency medicine
- Trauma surgery
- Public health
Background
- Severe traumatic brain injury (TBI) is a major cause of death in children.
- The influence of emergency medical services (EMS) prehospital times on pediatric TBI survival is not well understood.
- Investigating prehospital care practices is crucial for improving outcomes in pediatric severe TBI.
Purpose Of The Study
- To examine the association between EMS time on scene and mortality (dead-on-arrival status) in pediatric severe TBI patients.
- To explore how social determinants of health may impact prehospital care for these patients.
- To understand the relationship between EMS scene duration and survival probability.
Main Methods
- Retrospective cohort study utilizing data from the American College of Surgeons Trauma Quality Improvement Program (2017-2022).
- Inclusion of pediatric patients (<18 years) with severe TBI (Glasgow Coma Scale ≤8).
- Hierarchical logistic regression and random forest models were used to analyze the association between EMS time on scene and dead-on-arrival status, with LOESS plots for visualization.
Main Results
- Of 1,225 pediatric severe TBI patients, 5.6% were dead on arrival.
- Increased EMS time on scene was associated with decreased odds of being dead on arrival (OR, 0.92; P=0.025).
- A non-linear relationship was observed, with survival probability increasing up to ~12 minutes on scene before plateauing and decreasing; racial disparities in scene times and air medical dispatch were noted.
Conclusions
- EMS time on scene, up to a certain duration, is associated with reduced mortality in pediatric severe TBI patients, likely due to on-scene stabilization.
- These findings question the sole reliance on rapid transport and highlight the importance of prehospital interventions.
- Significant racial disparities in EMS scene times and ambulance dispatch necessitate further investigation into equitable prehospital care practices.
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