title: The importance of pre-trauma centre treatment of life-threatening events on the mortality of patients transferred with severe trauma.
abstract: OBJECTIVE
  The benefit of a well organised trauma system is acknowledged but doubts remain concerning the optimal pre-hospital trauma care model. We hypothesise that the treatment of life-threatening events before arrival at trauma centre--either pre-hospital or first hospital--may be more relevant to decreasing mortality than shortening the time to trauma centre.
  
  
  METHODS
  A cohort of 727 trauma patients with life-threatening events--identified as airway, breathing, circulation or neurological disability--requiring transfer to a trauma centre were studied. Data on patient's characteristics, trauma features, and mortality were taken from a trauma registry. Patients were divided into 3 groups depending on the place of treatment of life-threatening events: pre-hospital, first hospital or trauma centre. Survival Kaplan-Meier curves and logistic regression were used to assess the effect of place of treatment of life-threatening events on mortality.
  
  
  RESULTS
  Patients from the pre-hospital and first hospital groups had 20% and 27% mortality respectively, compared to 38% among those whose life-threatening events were corrected only at the trauma centre. Logistic regression showed that patients whose life-threatening events were corrected only at the trauma centre had an odds of death 3.3 times greater than those from the pre-hospital group, adjusted for patient and trauma characteristics and time to trauma centre.
  
  
  CONCLUSIONS
  In trauma patients requiring transfer to a trauma centre, pre-hospital interventions to treat life-threatening events may significantly decrease mortality when compared to similar interventions performed later at the trauma centre.
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001 Porto, Portugal. gomes.ernestina@gmail.com
authors.forename: Ernestina
authors.initials: E
authors.lastname: Gomes
authors.forename: Rui
authors.initials: R
authors.lastname: Araújo
authors.forename: António
authors.initials: A
authors.lastname: Carneiro
authors.forename: Cláudia
authors.initials: C
authors.lastname: Dias
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012044:Regression Analysis; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality*