[The reality of preclinical treatment in thoracic trauma - a prospective study]

Abstract

Aim of the study: Because of the well proven fact of outcome improvement by early, preclinical intubation and ventilation of multiple injured and polytraumatized patients, the guidelines of different medical associations recommend this procedure especially in combination with blunt chest trauma. By the means of a prospective study protocol we analyzed whether these treatment standards were respected and whether the kind of preclinical treatment was influencing treatment outcome.

Patients and methods: Using a prospective study protocol data were sampled and analyzed. From 1.12.2000 to 25.9.2001 48 consecutive patients were included into the protocol. 12 patients (25 %) had preclinical intubation (group A). 8 patients of group A were intubated by the helicopter emergency team. 36 patients had no tracheal tube (group B). In 34 cases mechanical ventilation has to be started during the emergency room procedures. Two patients were intubated after they were admitted to the intensive care unit (ICU). Insertion of a chest tube was done in 5 patients at the scene by the emergency team, in 15 cases after admission to the hospital and 21 at the ICU. Although the average age of years of patients was higher in group B (37,2 +/- 15,0 y vs. 46,9 +/- 21,1 y), p values calculated by ANOVA test revealed no significant difference. The two groups did not differ regarding to injury severity assessed by the "Injury severity score" (group A: 30,9 +/- 13,3; group B: 29,5 +/- 9,2). The mean duration of mechanical ventilation was 9,4 +/- 9,0d vs. 19,2 +/- 20,4 d in group A vs group B. Patients of group A required intensive care treatment for 12,6 +/- 8,7d vs 21,9 +/- 20,4 d of group B. One patient of group A died because of severe cranio cerebral trauma. 13 Patients of group B died (1 x pulmonal embolism, 12 x multiple organ failure).

Conclusions: Assessment of injury severity by the emergency medical teams failed in a very high percentage. Especially the blunt trauma to the chest was not diagnosed and therefore not respected.