title: Prehospital trauma life support training of ambulance caregivers and the outcomes of traffic-injury victims in Sweden.
abstract: BACKGROUND
  There is limited evidence that the widely implemented Prehospital Trauma Life Support (PHTLS) educational program improves patient outcomes. The primary aim of this national study in Sweden was to investigate the association between regional implementation of PHTLS training and mortality after traffic injuries.
  
  
  METHODS
  We extracted information from the Swedish National Patient Registry and the Cause of Death Registry on victims of motor-vehicle traffic injuries in Sweden from 2001 to 2004 (N = 28,041). During this time period, PHTLS training was implemented at a varying pace in different regions. To control for other influences on patient outcomes related to regional and hospital-level effects, such as variations in performance of trauma care systems, we used Bayesian hierarchical regression models to estimate odds ratios for prehospital mortality and 30-day mortality after hospital admission. We also controlled for the calendar year for each injury to account for period effects. We analyzed the time to death after hospital admission and time to return to work using Cox's proportional hazards frailty models.
  
  
  RESULTS
  After multivariable adjustment, the odds ratio for prehospital mortality with PHTLS-trained prehospital staff was 1.54 (95% credibility interval, 1.07-2.13). For 30-day mortality among those surviving to hospital admission, the odds ratio was 0.85 (95% credibility interval, 0.45-1.48). There was no association between PHTLS training and time to death (hazard ratio = 0.99; 95% CI, 0.85-1.14) or time to return to work (hazard ratio = 0.98; 95% CI, 0.92-1.05).
  
  
  CONCLUSIONS
  In this observational study, the implementation of PHTLS training did not appear to be associated with reduced mortality or ability to return to work after motor-vehicle traffic injuries.
authors: Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden. Electronic address: hans.blomberg@akademiska.se.
authors: Hans
authors: H
authors: Blomberg
authors: Bodil
authors: B
authors: Svennblad
authors: Karl
authors: K
authors: Michaelsson
authors: Liisa
authors: L
authors: Byberg
authors: Jakob
authors: J
authors: Johansson
authors: Rolf
authors: R
authors: Gedeborg
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D003479:Curriculum; D004509:Education, Nursing, Continuing / Q000379:methods*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D062707:Return to Work / Q000706:statistics & numerical data; D013548:Sweden; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: HR; ICISS; International Classification of Disease Injury Severity Score; OR; PHTLS; Prehospital Trauma Life Support; hazard ratio; odds ratio