The study here describes the association of total prehospital time and in-hospital mortality in prehospital, physician-staffed trauma systems in France, with the hypothesis that total prehospital time is associated with increased mortality.

The concept of time as an essential determinant of outcome in the early care of trauma patients is a prevailing doctrine, captured in the term the golden hour of trauma. The concept of trauma as a time-sensitive condition has guided education and policy for decades in the international trauma community. 

This cohort study was conducted from January 2009 to December 2016 and a total of 10, 216 patients were included. On unadjusted analysis, increasing prehospital times (in 30-minute categories) were associated with a markedly and constant increase in the risk of in-hospital death. The odds of death increased by 9% for each 10-minute increase in prehospital time and after adjustment by 4%.

In conclusion, the study demonstrates an independent association of in-hospital, all-cause mortality in trauma with total prehospital time in a physician-staffed EMS in France. The study argues that clinicians should still perform crucial interventions to meet each patient’s critical needs. As the critical association of time and trauma hemorrhage was recently observed demonstrating peak mortality from hemorrhage at 37 minutes, the appropriate hemorrhage control should be conducted as quickly as possible already in the prehospital phase. The whole process needs streamlining to keep total prehospital time as short and safe as possible, to only address the targeted and individualized essential needs of each patient that are of benefit to that patient.

 

Read about the Golden Hour of Trauma.

Read the original article here. https://jamanetwork.com/journals/jamasurgery/fullarticle/2751937

 

 

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