title: Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes.
abstract: BACKGROUND
  In patients with severe head injuries, transportation to a trauma centre within the "golden hour" are important markers of trauma system effectiveness but evidence regarding impacts on patient outcomes is limited.
  
  
  OBJECTIVE
  To determine the effect of patient arrival within the golden hour on patient outcomes.
  
  
  METHODS
  A retrospective cohort of adult patients with severe head injuries (head AIS ≥ 3) arriving within 24h of injury was identified using the trauma registry from 2000 to 2011. Survival analysis was used to determine the effect of patient arrival time on overall mortality. Study outcomes were in hospital mortality and survival to hospital discharge without requiring transfer for ongoing rehabilitation or nursing home care.
  
  
  RESULTS
  There was a significant association with mortality with each incremental minute of patient arrival (HR 1.002, 95%CI 1.001-1.004, p=0.001). There was however no survival benefit observed for patients arriving within 60 min of injury time (HR 0.77, 95%CI 0.50-1.18, p=0.22) but an apparent benefit for those presenting within 2h of injury time (HR 0.31, 95%CI 0.15-0.66, p=0.002). Patient arrival within 60 min of injury time was associated with increased odds of survival to hospital discharge without requiring ongoing rehabilitation (OR 1.78, 95%CI 1.14-2.79, p=0.01).
  
  
  CONCLUSIONS
  A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour. There was evidence of improved functional outcomes in patients arriving within 60 min of injury time.
authors.affiliation: Royal Prince Alfred Hospital, Trauma Office level 10, Missenden Road, Camperdown, NSW 2050, Australia. Dinh.mm@gmail.com
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
authors.forename: Kendall
authors.initials: K
authors.lastname: Bein
authors.forename: Susan
authors.initials: S
authors.lastname: Roncal
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Byrne
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petchell
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances; D001315:Australia / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome