The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity.
BACKGROUND
To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established


METHODS
The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge.


RESULTS
Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16).


CONCLUSIONS
The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.
Stiell
Ian G
IG
The Department of Emergency Medicine, University of Ottawa, and the Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ont.
Nesbitt
Lisa P
LP
Pickett
William
W
Munkley
Douglas
D
Spaite
Daniel W
DW
Banek
Jane
J
Field
Brian
B
Luinstra-Toohey
Lorraine
L
Maloney
Justin
J
Dreyer
Jon
J
Lyver
Marion
M
Campeau
Tony
T
Wells
George A
GA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000193:education; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007442:Intubation, Intratracheal; D008020:Life Support Care / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D016019:Survival Analysis; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*