Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients.
A sample of 360 severely injured patients was selected from a cohort of 8007 trauma victims followed prospectively from the time of injury to death or discharge. A case referent study was used to test the association between on-site care, total prehospital time, and level of care at the receiving hospital with short-term survival. Multiple logistic regression analyses showed that use of Advanced Life Support (ALS) at the scene was not associated with survival, whereas treatment at a level I compatible hospital was associated with a 38% reduction in the odds of dying, which approached statistical significance. Total prehospital time over 60 minutes was associated with a statistically significant adjusted relative odds of dying (OR = 3.0). The results of this study support the need for regionalization of trauma care and fail to show a benefit associated with ALS.
Sampalis
J S
JS
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Lavoie
A
A
Williams
J I
JI
Mulder
D S
DS
Kalina
M
M
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D006760:Hospitalization; D006801:Humans; D008020:Life Support Care; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012044:Regression Analysis; D012306:Risk; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*