title: Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain).
abstract: BACKGROUND
  Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of "comprehensive care" can prevent deaths and disabilities as well as limit the severity and pain caused by trauma.
  
  
  OBJECTIVE
  To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain.
  
  
  METHODS
  A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center "112," pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management.
  
  
  RESULTS
  There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1-13.1), RTS (OR 0.58, 95% CI 0.5-0.7), and ISS score (OR 1.05, 95% CI 1.0-1.1).
  
  
  CONCLUSIONS
  Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others.
authors.affiliation: Pre-hospital Emergency Medical Services (UVI-Móvil Pamplona), Pamplona, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Gómez de Segura Nieva
authors.forename: Mercedes Marraco
authors.initials: MM
authors.lastname: Boncompte
authors.forename: Alfredo Echarri
authors.initials: AE
authors.lastname: Sucunza
authors.forename: Clint Luise Jean
authors.initials: CL
authors.lastname: Louis
authors.forename: María
authors.initials: M
authors.lastname: Seguí-Gómez
authors.forename: Tomás Belzunegui
authors.initials: TB
authors.lastname: Otano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003191:Comprehensive Health Care / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy*; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology