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. 2013 Jan;6(1):16-20.
doi: 10.4103/0974-2700.106320.

Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

Mamta Swaroop  1 , David C Straus, Ogo Agubuzu, Thomas J Esposito, Carol R Schermer, Marie L Crandall
Affiliations

Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

Mamta Swaroop et al. J Emerg Trauma Shock. 2013 Jan.

Abstract

Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems. This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries.

Materials and methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003. Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software.

Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving. Patients with higher injury severity scores (ISS) were transported more quickly. Injury severity scores (ISS) ≥16 and emergency department (ED) hypotension (systolic blood pressure, SBP <90) strongly predicted mortality (P < 0.05 for each). In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05). This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001).

Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner. Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival. These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

Keywords: Golden Hour; penetrating trauma mortality; pre-hospital transport time; urban trauma systems.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Death ratefor non-hypotensive patients with penetrating thoracic injuries and hypotensive patients with penetrating thoracic injuries patients grouped by pre-hospital time
Figure 2
Figure 2
RR of death for hypotensive patients with penetrating thoracic injuries vs. non-hypotensive patients with penetrating thoracic injuries patients grouped by pre-hospital time
See this image and copyright information in PMC

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