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A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

Authors
  • Bedard, Alexander F.1, 2
  • Mata, Lina V.1
  • Dymond, Chelsea1, 3
  • Moreira, Fabio4
  • Dixon, Julia1
  • Schauer, Steven G.5
  • Ginde, Adit A.1
  • Bebarta, Vikhyat1
  • Moore, Ernest E.1, 6
  • Mould-Millman, Nee-Kofi1
  • 1 University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA , Aurora (United States)
  • 2 United States Air Force Medical Corps, 7700 Arlington Boulevard, Falls Church, VA, 22042, USA , Falls Church (United States)
  • 3 Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, 80204, USA , Denver (United States)
  • 4 Western Cape Government, Emergency Medical Services, 9 Wale Street, Cape Town, 8001, South Africa , Cape Town (South Africa)
  • 5 US Army Institute of Surgical Research, 3698 Chambers Rd., San Antonio, TX, 78234, USA , San Antonio (United States)
  • 6 Ernest E. Moore Shock Trauma Center at Denver Health, 777 Bannock St, Denver, CO, 80204, USA , Denver (United States)
Type
Published Article
Journal
International Journal of Emergency Medicine
Publisher
Springer Berlin Heidelberg
Publication Date
Dec 09, 2020
Volume
13
Issue
1
Identifiers
DOI: 10.1186/s12245-020-00324-7
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundAnnually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation.Main bodyWe performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure.ConclusionThe existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.

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