Temporal changes in the prehospital management of trauma patients: 2014-2021

James M Bradford; Pedro G Teixeira; Joseph DuBose; Marc D Trust; Tatiana Cp Cardenas; Simin Golestani; Jessica Efird; James Kempema; Jessica Zimmerman; Clea Czysz; Michelle Robert; Sadia Ali; Lawrence H Brown; Carlos Vr Brown

doi:10.1016/j.amjsurg.2023.08.001

Temporal changes in the prehospital management of trauma patients: 2014-2021

Am J Surg. 2024 Feb:228:88-93. doi: 10.1016/j.amjsurg.2023.08.001. Epub 2023 Aug 6.

Authors

Affiliations

¹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: James.bradford@utexas.edu.
² Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: pgteixeira@austin.utexas.edu.
³ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: joseph.dubose@austin.utexas.edu.
⁴ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: mdtrust@ascension.org.
⁵ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: tatiana.cardenas@ascension.org.
⁶ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: sgolestani@mcw.edu.
⁷ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: Jessica.efird@ascension.org.
⁸ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: jkempema@ascension.org.
⁹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: jessicaturner@utexas.edu.
¹⁰ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: cczysz@ascension.org.
¹¹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: michelle.robert@ascension.org.
¹² Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: Sali2@ascension.org.
¹³ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: lhbrown@ascension.org.
¹⁴ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: carlos.brown@austin.utexas.edu.

PMID: 37567816
DOI: 10.1016/j.amjsurg.2023.08.001

Abstract

Introduction: Aggressive prehospital interventions (PHI) in trauma may not improve outcomes compared to prioritizing rapid transport. The aim of this study was to quantify temporal changes in the frequency of PHI performed by EMS.

Methods: Retrospective chart review of adult patients transported by EMS to our trauma center from January 1, 2014 to 12/31/2021. PHI were recorded and annual changes in their frequency were assessed via year-by-year trend analysis and multivariate regression.

Results: Between the first and last year of the study period, the frequency of thoracostomy (6% vs. 9%, p = 0.001), TXA administration (0.3% vs. 33%, p < 0.001), and whole blood administration (0% vs. 20%, p < 0.001) increased. Advanced airway procedures (21% vs. 12%, p < 0.001) and IV fluid administration (57% vs. 36%, p < 0.001) decreased. ED mortality decreased from 8% to 5% (p = 0.001) over the study period. On multivariate regression, no PHI were independently associated with increased or decreased ED mortality.

Conclusion: PHI have changed significantly over the past eight years. However, no PHI were independently associated with increased or decreased ED mortality.

Keywords: Emergency medical services; Prehospital interventions; Trauma prehospital.

MeSH terms

Adult
Emergency Medical Services* / methods
Humans
Retrospective Studies
Thoracostomy
Trauma Centers