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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 and 4 more

American Journal of Surgery · 2023-08-06 · Observational study

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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.

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Tags

Blood products · Fluids & blood · Haemostatics · Endotracheal intubation · Mortality & survival · Thoracostomy · Tranexamic acid

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