A comparison of prehospital and hospital data in trauma patients.
OBJECTIVE
The use of prehospital data as an indicator for trauma team activation has been established. The relationship between field (Fd) and emergency department (ED) systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, and airway control as it relates to outcomes is unclear. We hypothesized that ED and Fd physiologic parameters are equally valid predictors of outcomes. In addition, we hypothesized that early field intubation will improve survival compared with later ED intubation.


METHODS
Trauma registry data from two academic Level I centers from 1994 to 2001, excluding all transfers and burn patients, were analyzed using Wilcoxon signed-rank test and multivariate logistic regression with appropriate adjustments.


RESULTS
There were 19,409 patients, 16,277 blunt and 3,132 penetrating trauma. There were 3,571 Fd and 746 ED intubations. ED intubation was associated with increased risk of fatal outcome compared with nonintubated patient (adjusted odds ratio, 3.1; p < 0.0001) and field intubations (adjusted odds ratio, 3.0; p < 0.0001). ED-GCS score was not significantly different from Fd-GCS score, with 82% having the same GCS category. This was not the case for SBP, and only in 60% of the cases were ED-SBP and Fd-SBP in the same category. In 31% of the patients, the ED-SBP increased, and in 9% of cases, the ED-SBP decreased compared with Fd-SBP. This was true for both blunt and penetrating trauma. Both Fd-SBP and ED-SBP were independent predicators of fatal outcome, and mortality rate significantly increased if ED-SBP category decreased compared with Fd-SBP.


CONCLUSIONS
Early field intubation was associated with a decreased risk of fatal outcome compared with ED intubation. ED-GCS score was not significantly different from Fd-GCS score, and either one can be used to predict fatal outcome. However, ED-SBP was different from Fd-SBP in 40% of the patients, with the majority of cases having higher ED-SBP. Although ED-SBP was a better predictor of outcome, the best model is achieved when both ED and field SBP are used.
Arbabi
Saman
S
Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA. sarbabi@umich.edu
Jurkovich
Gregory J
GJ
Wahl
Wendy L
WL
Franklin
Glen A
GA
Hemmila
Mark R
MR
Taheri
Paul A
PA
Maier
Ronald V
RV
D000328:Adult; D001795:Blood Pressure Determination / Q000592:standards*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008824:Michigan / Q000453:epidemiology; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014193:Trauma Centers; D014861:Washington / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000145:classification / Q000401:mortality / Q000628:therapy