Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study.
BACKGROUND
Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality.


METHODS
The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality.


RESULTS
Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results.


CONCLUSIONS
This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.
Université de Bourgogne, Service d'Anesthésie et Réanimation - SAMU 21, Hôpital Général, 3 Rue Faubourg Raines, Centre Hospitalier Universitaire de Dijon, Faculté de médecine, 21033 Dijon Cedex, France. yeguiayan.jeanmichel@neuf.fr
Jean-Michel
JM
Yeguiayan
Delphine
D
Garrigue
Christine
C
Binquet
Claude
C
Jacquot
Jacques
J
Duranteau
Claude
C
Martin
Fatima
F
Rayeh
Bruno
B
Riou
Claire
C
Bonithon-Kopp
Marc
M
Freysz
D000293:Adolescent; D000328:Adult; D000368:Aged; D004632:Emergency Medical Services; D061388:Firefighters; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
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