Propensity for performing interventions in pre-hospital trauma management – a comparison between physicians and non-physicians

Journal of Trauma Management & Outcomes

Kjell Ivarsson³  Ludwig Aspelin¹  Mathias C Blom² 

[1] Ortopediska kliniken, Falu lasarett, Landstinget Dalarna, Box 712, Falun SE 791 29, Sweden;IKVL, Medicine, Lund University, IKVL/Avd för medicin, Hs 32, EA-blocket, plan 2, Universitetssjukhuset, Lund SE 221 85, Sweden;Head of division: “Specialiserad närsjukvård Skånevård SUND”, Medicon Village, Tunavägen 3, Lund SE 22363, Sweden

关键词: Prehospital;    Emergency care;    Emergency;    Medical services;    Trauma;   

Others  :  800840
DOI  :  10.1186/1752-2897-8-3

 received in 2013-06-03, accepted in 2014-02-04,  发布年份 2014

【 摘 要 】

Background

In 2005, the Advanced Life Support (ALS) teams delivering pre-hospital care in RegionSkane in southern Sweden received additional support by physicians, who were part of “Pre-hospital acute teams” (PHAT). The study objective is to compare the incidence of pre-hospital medical interventions for trauma-patients cared for by conventional ALS teams and patients who received additional support by PHAT.

Methods

Trauma patients with Injury Severity Score (ISS) >9 were identified retrospectively in the national quality registry KVITTRA at three hospitals in RegionSkane, for the time period October 2005 to December 2008. Interventions include e.g. tracheal intubation, administration of i.v. fluids, neck immobilization and spine board usage. Confounding effects from trauma severity, trauma mechanism, vital parameters, age and sex were addressed in multivariate models.

Results

Data from 202 cases was included. 9 pre-hospital interventions were assessed. The incidence of endotracheal intubation and immobilisation of extremities was higher among patients in the PHAT-group compared to the ALS-only group (16.3% vs. 6.9%, p = 0.034) and (12.8% vs. 4.3%, p = 0.027) respectively. PHATs presence remained a significant predictor of these interventions also after taking confounding factors into account (OR 5.5, CL 1.5-19.7) and (OR 3.2 CI 1.0-9.8).

PHAT was involved in a greater proportion of cases with <50.0% of survival (19.8% vs. 12.1%, p = 0.134). The average ISS was higher among cases receiving PHAT support in strata ISS 16-24 and ISS > 24 than cases in corresponding strata cared for by ALS teams alone (ISS 20.0 vs. 17.0, p = 0.048 and ISS 34.0 vs. 29.0, p = 0.019).

Conclusions

The incidence of endotracheal intubation and immobilization of extremities was greater among patients supported by PHAT, compared to patients cared for by ALS teams alone. This finding has to be interpreted in the light of a selection-bias where PHAT support was directed to more severely injured patients.

【 授权许可】

   
2014 Blom et al.; licensee BioMed Central Ltd.

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