The association of mobile medical team involvement on on-scene times and mortality in trauma patients.
OBJECTIVE
Mobile medical teams (MMTs) provide specialized care on-scene with the purpose to improve outcome. However, this additional care could prolong the on-scene time (OST), which is related to mortality. The purpose of this study was to assess the effects of MMT involvement on the mortality rate and on the OST, in a Dutch consecutive cohort of Level I trauma patients.


METHODS
All patients who required presentation in the trauma resuscitation room in an urban Level I trauma center were included in this prospective study during the period of November 2005 till November 2007. For data collection, we used both pre- and in-hospital registration systems. Outcome measures were 30-day mortality and OST.


RESULTS
In total, 1,054 patients were analyzed. In 172 (16%) patients, the MMT was involved. Mortality was significantly higher in the MMT group compared with patients treated without MMT involvement; 9.9% versus 2.7%, respectively (p < 0.001). Significantly higher Injury Severity Scores, intervention rates, and a significantly lower Triage Revised Trauma Score were found in patients treated by MMT. After adjustment for patient and injury characteristics, no association could be found between MMT involvement and higher mortality (95% CI, 0.581-3.979; p = 0.394). In patients with severe traumatic brain injury (GCS score ≤ 8) in whom a MMT was involved, the mortality was 25.5%, compared with 32.7% in those without MMT involvement (p = 0.442). The mean OST was prolonged (2.7 minutes) when MMT was involved (26.1 vs. 23.4 minutes; p = 0.003).


CONCLUSIONS
In this study, OSTs were long compared with PHTLS recommendations. MMT involvement slightly prolonged the OST. Trauma patients with MMT involvement had a high mortality, but after correction for patient and injury characteristics, the mortality rate did not significantly differ from patients without MMT involvement.
Aydin
Sema
S
Trauma Unit Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Overwater
Eline
E
Saltzherr
Teun Peter
TP
Jin
P H Ping Fung Kon
PH
van Exter
Pieternel
P
Ponsen
Kees Jan
KJ
Luitse
Jan S K
JS
Goslings
J Carel
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000706:statistics & numerical data*; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D013997:Time Factors; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy; D055815:Young Adult