A M K Harmsen1, G F Giannakopoulos2, P R Moerbeek3, E P Jansma4, H J Bonjer3, F W Bloemers3. 1. Department of Surgery, VU university Medical Center, Amsterdam, The Netherlands. Electronic address: a.harmsen@vumc.nl. 2. Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands. 3. Department of Surgery, VU university Medical Center, Amsterdam, The Netherlands. 4. Medical Library, VU university Medical Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: Time is considered an essential determinant in the initial care of trauma patients. Salient tenet of trauma care is the 'golden hour', the immediate time after injury when resuscitation and stabilization are perceived to be most beneficial. Several prehospital strategies exist regarding time and transport of trauma patients. Literature shows little empirical knowledge on the exact influence of prehospital times on trauma patient outcome. The objective of this study was to systematically review the correlation between prehospital time intervals and the outcome of trauma patients. METHODS: A systematic review was performed in MEDLINE, Embase and the Cochrane Library from inception to May 19th, 2014. Studies reporting on prehospital time intervals for emergency medical services (EMS), outcome parameters and potential confounders for trauma patients were included. Two reviewers collected data and assessed the outcomes and risk of bias using the STROBE-tool. The primary outcome was the influence on mortality. RESULTS: Twenty level III-evidence articles were considered eligible for this systematic review. Results demonstrate a decrease in odds of mortality for the undifferentiated trauma patient when response-time or transfer-time are shorter. On the contrary increased on-scene time and total prehospital time are associated with increased odds of survival for this population. Nevertheless rapid transport does seem beneficial for patients suffering penetrating trauma, in particular hypotensive penetratingly injured patients and patients with a traumatic brain injury. CONCLUSION: Swift transport is beneficial for patients suffering neurotrauma and the haemodynamically unstable penetratingly injured patient. For haemodynamically stable undifferentiated trauma patients, increased on-scene-time and total prehospital time does not increase odds of mortality. For undifferentiated trauma patients, focus should be on the type of care delivered prehospital and not on rapid transport.
OBJECTIVE: Time is considered an essential determinant in the initial care of traumapatients. Salient tenet of trauma care is the 'golden hour', the immediate time after injury when resuscitation and stabilization are perceived to be most beneficial. Several prehospital strategies exist regarding time and transport of traumapatients. Literature shows little empirical knowledge on the exact influence of prehospital times on traumapatient outcome. The objective of this study was to systematically review the correlation between prehospital time intervals and the outcome of traumapatients. METHODS: A systematic review was performed in MEDLINE, Embase and the Cochrane Library from inception to May 19th, 2014. Studies reporting on prehospital time intervals for emergency medical services (EMS), outcome parameters and potential confounders for traumapatients were included. Two reviewers collected data and assessed the outcomes and risk of bias using the STROBE-tool. The primary outcome was the influence on mortality. RESULTS: Twenty level III-evidence articles were considered eligible for this systematic review. Results demonstrate a decrease in odds of mortality for the undifferentiated traumapatient when response-time or transfer-time are shorter. On the contrary increased on-scene time and total prehospital time are associated with increased odds of survival for this population. Nevertheless rapid transport does seem beneficial for patients suffering penetrating trauma, in particular hypotensive penetratingly injured patients and patients with a traumatic brain injury. CONCLUSION: Swift transport is beneficial for patients suffering neurotrauma and the haemodynamically unstable penetratingly injured patient. For haemodynamically stable undifferentiated traumapatients, increased on-scene-time and total prehospital time does not increase odds of mortality. For undifferentiated traumapatients, focus should be on the type of care delivered prehospital and not on rapid transport.
Authors: Karim Asehnoune; Zsolt Balogh; Giuseppe Citerio; Andre Cap; Timothy Billiar; Nino Stocchetti; Mitchell J Cohen; Paolo Pelosi; Nicola Curry; Christine Gaarder; Russell Gruen; John Holcomb; Beverley J Hunt; Nicole P Juffermans; Mark Maegele; Mark Midwinter; Frederick A Moore; Michael O'Dwyer; Jean-François Pittet; Herbert Schöchl; Martin Schreiber; Philip C Spinella; Simon Stanworth; Robert Winfield; Karim Brohi Journal: Intensive Care Med Date: 2017-07-29 Impact factor: 17.440
Authors: Michael S Farrell; Benjamin Emery; Richard Caplan; John Getchell; Mark Cipolle; Kevin M Bradley Journal: Am J Surg Date: 2020-01-22 Impact factor: 2.565
Authors: Rebecca G Maine; Chifundo Kajombo; Gift Mulima; Jennifer Kincaid; Laura Purcell; Jared R Gallaher; Trista D Reid; Anthony G Charles Journal: World J Surg Date: 2020-06 Impact factor: 3.352
Authors: Gavin Tansley; Nadine Schuurman; Matthew Bowes; Mete Erdogan; Robert Green; Mark Asbridge; Natalie Yanchar Journal: Can J Surg Date: 2019-04-01 Impact factor: 2.089
Authors: Eveline A J van Rein; Rogier van der Sluijs; Frank J Voskens; Koen W W Lansink; R Marijn Houwert; Rob A Lichtveld; Mariska A de Jongh; Marcel G W Dijkgraaf; Howard R Champion; Frank J P Beeres; Luke P H Leenen; Mark van Heijl Journal: JAMA Surg Date: 2019-05-01 Impact factor: 14.766
Authors: Aodhnait S Fahy; Ryan M Antiel; Stephanie F Polites; Michael B Ishitani; Christopher R Moir; Martin D Zielinski Journal: J Pediatr Surg Date: 2015-10-31 Impact factor: 2.545