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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 139-142

The impact of prehospital emergency services on the outcome of trauma patients


Department of Emergency Medicine, Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran

Date of Submission01-Sep-2019
Date of Acceptance20-Jul-2020
Date of Web Publication22-Aug-2020

Correspondence Address:
Dr. Moloud Balafar
Emergency Medicine Research Team, Tabriz University of Medical Sciences, Golgasht Street, Tabriz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atr.atr_75_19

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  Abstract 


Background and Objectives: Trauma is one of the most important health problems in the world, and shock index is a good tool for evaluating trauma patients in emergency. The aim of this study was to evaluate the impact of prehospital emergency on the outcome of trauma patients. Methods: In this cross-sectional study, we investigated the records of 359 patients referred to the emergency department; they were selected non-randomly. Demographic information, trauma mechanism, patients' transportation, location and duration of hospitalization and the final outcomes of the patients were evaluated. the predictive power of the shock index in hospitalization and mortality was studied. The data were analyzed by SPSS software using descriptive and analytical statistics. Results: The results of study showed that 73.3% of patients were male and 26.7% were female with a median of 30 years. Car and motorcycle accidents and falling from altitude were the most common mechanisms of trauma and cause of death. Time interval between trauma and emergency shock index and patient status was normal and significant ( P < 0.7). Conclusion: The rate of patients who were transferred by EMS is equal with those transferred by witness. Patients who had normal shock index with delay transfer time had a significantly high mortality rate.

Keywords: Emergency department, mortality, prehospital, trauma


How to cite this article:
Pouraghaei M, Vahdati SS, Moharamzadeh P, Abrishami L, Balafar M. The impact of prehospital emergency services on the outcome of trauma patients. Arch Trauma Res 2020;9:139-42

How to cite this URL:
Pouraghaei M, Vahdati SS, Moharamzadeh P, Abrishami L, Balafar M. The impact of prehospital emergency services on the outcome of trauma patients. Arch Trauma Res [serial online] 2020 [cited 2020 Sep 22];9:139-42. Available from: http://www.archtrauma.com/text.asp?2020/9/3/139/292958




  Introduction Top


Prehospital care is one of the key pillars of the trauma care system and is defined as the beginning of care for trauma patients at the scene of the accident as soon as possible. This care begins at the scene of the accident and ends in a hospital emergency. Prehospital trauma care includes providers, trauma information systems, casualty transfer facilities, and communication systems.[1]

In general, the postaccident phase involves the application and implementation of appropriate care and treatment in the prehospital and hospital phases to prevent the trauma and mortality consequences thereof. Trauma-related deaths are categorized into three groups based on time criteria, which include strategies to reduce trauma-related deaths.[2]

The results of Feero et al. showed that there was no significant difference between unexpected survivors versus unexpected deaths.[3] Newgard et al. also indicated no significant association between mortality and transfer time in minutes.[4]

However, Gonzalez et al. and Petri et al. studied that nonsurvivors have a significant shorter transfer time.[5],[6] In the study of McGuffie et al. with urban or rural patients, the authors reported that there was no association between mortality and transfer time in both rural and urban settings. However, they showed transfer time to be a significant factor when total length of hospital stay was modeled, and longer transfer time was associated with a longer hospital stay. Three studies report on patients suffering penetrating trauma.[7] Eachempati et al. and McCoy et al. reported that there was not any increase of mortality with longer transfer time.[8],[9]

In unknown injury in trauma patients, a shorter response time and also transfer time can have a positive effect on mortality.[10]

The aim of this study was to evaluate the impact of prehospital emergency on the outcome of trauma patients.


  Methods Top


Study type

This was cross-sectional analytical study was conducted on all multiple trauma patients referred to the Emergency Department of Imam Reza Hospital in Tabriz (the largest trauma center in northwestern of Iran) from Fall 2017 to Winter 2018.

Demographic data (age and sex), patient information such as trauma mechanism and type of trauma, patients' transport, and outcome of patients were collected by the researcher in this study. For this purpose, a special form of data collection was prepared and the data were collected from patients' medical records during treatment.

In this study, a total number of 359 patients referred to Imam Reza Hospital in Tabriz were selected. Shock index criterion was extracted from patients' records and recorded in relevant forms.[11] It should be noted that the results of the study did not directly interfere with the patient's treatment process and only the patients' workflow was observed and the checklist was filled.

Data analysis

The data were analyzed by the SPSS software version 22 IBM SPSS statistics for Windows, version 22.0; New York. Results were reported in frequency (percent) as well as mean, standard deviation, and by median (interquartile range). Kolmogorov–Smirnov test was used to test the normality of the data distribution. P < 0.05 was considered as the level of statistical significance.

Ethical considerations

This research was approved by the Ethics Committee and the Vice-Chancellor of Research and Technology of Tabriz University of Medical Sciences (Ethics No.IR.TBZMED.REC.1397533). Informed consent was obtained from the participants at the beginning of the study. Patients' information was completely confidential and the information used was reviewed without mentioning their personal identities.


  Results Top


In this study, 359 patients referred to the Emergency Department of Imam Reza Hospital were included. There were 263 (73.3%) male and 96 (26.7%) female patients. The mean age of the patients was 33.94 ± 18.89 years with a median of 30 years.

In this study, 309 patients (86.1%) were transferred with EMS to the emergency department and 50 patients (13.9%) were transferred with witness. In this study, the highest frequency of trauma was car and motorcycle accidents (44.30%) and the least one was fight (8.60%). [Table 1] shows the relationship between trauma mechanism and patients' status using the shock index.
Table 1: Relationship between trauma mechanism and patient status based on shock index

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In patients who were transferred by EMS, 57 (18.4%) died, 200 (64.7%) discharged, and 52 (16.8%) transferred to other specific centers. In patients transferred with witness, 1 (2%) died, 38 (76%) were discharged, and 11 (22%) were transferred to other centers (P = 0.013).

The time interval between trauma and emergency arrival for patients who were transferred with EMS was between 60 min and 100 min (minimum 60–maximum 100 min) and for patients who were transferred with witness, the median was 60 min with the quartile range (minimum 60–maximum 100 min), with no significant difference between the two groups (P = 0.225).

The time interval between trauma and EMS arrival among those with a shock index below 0.7 and normal who died was more than those who were discharged or transferred to other centers (P = 0.021 and P = 0.003, respectively). However, there was no statistically significant difference between patients with positive index in terms of time interval between trauma and EMS arrival (P = 0.996) [Table 2] and [Table 3].
Table 2: Differentiation between shock index and patient status

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Table 3: Time interval between trauma occurrence and EMS arrival based on shock index and patient outcome

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  Discussion Top


According to the results of the present study, the most common cause of trauma was car and motorcycle accidents and falling from altitude. Most of the deaths and the need for hospitalization in ICUs also occurred in trauma patients with these two mechanisms. It seems that Tabriz city drivers do not comply with traffic laws, disregard for safety and discretion when using vehicles, and neglect of traffic signs in urban areas due to a higher prevalence of the mentioned mechanisms. Zamani et al., in 2014, identified the most common cause of trauma as a car accident and falling from a height, which is in line with the present study.[12] Also, Kariman et al. indicated that the most common cause of trauma was accident, which is consistent with the present study.[13] This has also been confirmed in a study by Zarger et al.[14]

The findings of the study indicate that men are more likely to be hospitalized than women due to trauma (2.8 times); this finding is quite in line with the results of Zamani et al.[12] A study conducted in Tehran also reported men as the most at - risk group.[14],[15] The high rate of trauma in men is justified by the economic, social, and cultural conditions of the community (more housewives in the community and more men involved in the transportation system).

The mean age of trauma patients was 30 years, and trauma was the highest in the age group of 21–46 years old, indicating that most of the injured were active working age. These statistics are similar to most studies in Iran.[15],[16]

Transfer of injured patients to hospital is one of the most important issues in developed countries.[17] In the present study, the majority of the patients (86%) were transferred to the emergency room by a prehospital emergency, and approximately 14% of the patients referred to these centers by personal device. These results were in contrast to the findings of studies conducted in Isfahan in 2014[13] and also in Tehran and Ardabil. The percentage of referrals by prehospital emergency was 49.7 in Isfahan and 7.2 and 8.8 in Tehran and Ardabil, respectively. These values were 8.39%, 90%, and 36.3%, respectively, for conventional car transport.[14],[18]


  Conclusion Top


The most frequent cause of trauma was car crash. This study showed that the mortality rate of death in patients who were referred with EMS was high, maybe it depends on severity of injuries; in the other hand, the patients who were referred came with witness had no severe injury and because of that the mortality rate is low. It is so interesting that the rate of patients referred by EMS is equal with those transferred by witness. Patients who had normal shock index with delay transfer time had a significantly high mortality rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Norton R, Kobusingye O. Injuries. N Engl J Med 2013;368:1723-30.  Back to cited text no. 1
    
2.
Bryant RA, Creamer M, O'Donnell M, Silove D, Clark CR, McFarlane AC. Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury. J Int Neuropsychol Soc 2009;15:862-7.  Back to cited text no. 2
    
3.
Feero S, Hedges JR, Simmons E, Irwin L. Does out-of-hospital EMS time affect trauma survival? Am J Emerg Med 1995;13:133-5.  Back to cited text no. 3
    
4.
Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, et al. Emergency medical services intervals and survival in trauma: Assessment of the golden hour in a North American prospective cohort. Ann Emerg Med 2010;55:235-46.  Back to cited text no. 4
    
5.
Gonzalez RP, Cummings GR, Phelan HA, Mulekar MS, Rodning CB. Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis. Am J Surg 2009;197:30-4.  Back to cited text no. 5
    
6.
Petri RW, Dyer A, Lumpkin J. The effect of prehospital transport time on the mortality from traumatic injury. Prehosp Disaster Med 1995;10:24-9.  Back to cited text no. 6
    
7.
McGuffie AC, Graham CA, Beard D, Henry JM, Fitzpatrick MO, Wilkie SC, et al. Scottish urban versus rural trauma outcome study. J Trauma 2005;59:632-8.  Back to cited text no. 7
    
8.
Eachempati SR, Robb T, Ivatury RR, Hydo LJ, Barie PS. Factors associated with mortality in patients with penetrating abdominal vascular trauma. J Surg Res 2002;108:222-6.  Back to cited text no. 8
    
9.
McCoy CE, Sampson MM, Anderson S, Kahn CC. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban Level I trauma center. Ann Emerg Med 2013;61:167-74.  Back to cited text no. 9
    
10.
Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: A systematic review. Injury 2015;46:602-9.  Back to cited text no. 10
    
11.
Allgöwer M, Burri C. Shock index. Dtsch Med Wochenschr 1967;92:1947-50.  Back to cited text no. 11
    
12.
Zamani M, Esmailian M, Mirazimi MS, Ebrahimian M, Golshani K. Cause and final outcome of trauma in patients referred to the emergency department: A cross sectional study. Iran J Emerg Med 2014;1:22-7.  Back to cited text no. 12
    
13.
Kariman H, Hatamabadi HR, Mirfazli SA. The agreement of shock index and base defects in determining the severity of shock in multiple trauma patients. Iran J Emerg Med 2016;3:132-7.  Back to cited text no. 13
    
14.
Zargar M, Modaghegh MH, Rezaishiraz H. Urban injuries in Tehran: Demography of trauma patients and evaluation of trauma care. Injury 2001;32:613-7.  Back to cited text no. 14
    
15.
Yousefzadeh S, Ahmadi DM, Mohammadi MH, Dehnadi MA, Hemati H, Shaabani S. Epidemiology of Injuries and their Causes among Traumatic Patients Admitted into Poursina Hospital, Rasht (second half of the year 2005). Journal of Kermanshah University of Medical Sciences (Behbood) Fall 2007:11; 286-95.  Back to cited text no. 15
    
16.
Farzandipour M, Ghatan H, Mazrouei L, Nejati M, Agha BT. Epidemiological study of traumatic patients referred to neghavi hospital of kashan. Journal of Kermanshah University of Medical Sciences Spring 2007:11; 58-68.  Back to cited text no. 16
    
17.
Greenspan L, McLellan BA, Greig H. Abbreviated injury scale and injury severity score: A scoring chart. J Trauma 1985;25:60-4.  Back to cited text no. 17
    
18.
Amani F, Habinzadeh SH, Rostami KH. Specifications of traumatized patients referring to Fatemi hospital of Ardabil. Sci J Ardabil Univ Med Sci 2009;9:13-22.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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