Beyond the Golden Hour: Association of Prehospital Time and Intervention Quality With Functional Outcomes in Severely...

Trauma remains a major cause of mortality and disability worldwide, particularly in low- and middle-income countries (LMICs). Although the "golden hour" concept emphasises rapid transport after injury, emerging evidence suggests that the quality of prehospital care may influence outcomes more than transport time alone. Data evaluating the relationship between prehospital care and trauma outcomes in low-resource settings remains limited.

To evaluate the association between prehospital time and prehospital treatment with outcomes in severely injured trauma patients presenting to a tertiary care trauma centre.

This prospective observational cohort study was conducted in the Department of General Surgery at a tertiary care centre over 18 months. Seventy-five severely injured trauma patients aged more than 12 years with Revised Trauma Score (RTS) less than 4 or other criteria for severe trauma were included. Data regarding demographics, mechanism of injury, mode of transport, prehospital time, and prehospital interventions were collected using a predefined proforma. Prehospital interventions were categorised as none, non-Advanced Trauma Life Support (ATLS)-compliant, or ATLS-compliant. Primary outcomes included 30-day mortality, hospital length of stay, and time to return to work. Statistical analysis was performed using Chi-square or Fisher's Exact tests as appropriate, with p<0.05 considered significant.

The mean age of participants was 33 years, and 62 (83%) were male. Road traffic injuries were the most common mechanism of trauma (38, 51%). Most patients reached the tertiary centre within one to three hours of injury (25, 33%). ATLS-compliant prehospital intervention was received by only 20 (27%) patients. Overall mortality was observed in seven (9%). Prehospital time was not significantly associated with mortality, hospital stay duration, or return to work. However, ATLS-compliant prehospital intervention was significantly associated with shorter hospital stay and earlier return to work. No statistically significant association was observed between prehospital intervention and mortality.

Prehospital intervention quality, rather than prehospital transport time alone, was significantly associated with better functional recovery in severely injured trauma patients. ATLS-based prehospital stabilisation was associated with shorter hospitalisation and earlier return to work. These findings support strengthening structured prehospital trauma systems and protocol-driven emergency care in low-resource settings.