National variability in out-of-hospital treatment after traumatic injury.
OBJECTIVE
The optimal out-of-hospital treatment for trauma patients remains a subject of national debate. Researchers designing future studies to address these issues must understand the variability in treatment that exists across the United States. We define the variability in the out-of-hospital treatment provided to trauma patients in the United States.


METHODS
This was a retrospective analysis of prospectively collected data for a cohort study of trauma outcomes. The study was conducted at 15 urban or suburban regions across the United States, 18 Level I trauma centers and 51 nontrauma centers. We used a weighted population sample based on data from all hospital trauma deaths and a sample of patients discharged between January 2001 and December 2002. Entry criteria included at least 1 body region with an Abbreviated Injury Score greater than 3 and age between 18 and 84 years. Exclusion criteria were patient age greater than 65 years and isolated hip fractures and patients with burns.


RESULTS
Complete out-of-hospital data were available for 3,357 patients, representing a weighted population sample of 9,929 patients. Out-of-hospital treatment varied substantially among the regions, including out-of-hospital intubation (5% to 48%), use of neuromuscular blocking agents or sedatives to facilitate intubation (0% to 100%), surgical airway access (0.1% to 3.5%), peripheral and central intravenous access (22% to 95%), and needle thoracentesis (0% to 5%).


CONCLUSIONS
There is considerable national variability in out-of-hospital procedures performed for trauma patients.
Bulger
Eileen M
EM
Harborview Injury Prevention and Research Center, Seattle, WA 98104, USA. ebulger@u.washington.edu
Nathens
Avery B
AB
Rivara
Frederick P
FP
MacKenzie
Ellen
E
Sabath
Daniel R
DR
Jurkovich
Gregory J
GJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data; D015505:Chest Tubes / Q000706:statistics & numerical data; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000628:therapy; D011446:Prospective Studies; D017678:Sex Distribution; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000628:therapy; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000628:therapy