The impact of pre-hospital transport process optimization on rescue efficiency and complications in patients with traumatic intracranial hemorrhage.
The American journal of emergency medicine · 2026-01-23 · Quasi-experimental
Abstract
BACKGROUND: The pre-hospital phase is a critical factor affecting the prognosis of patients with traumatic intracranial hemorrhage (TICH). Early recognition, rapid transport, and optimized pre-hospital management can significantly influence patient outcomes. OBJECTIVE: To compare the impact of "traditional pre-optimized workflow" versus "post-optimization workflow" pre-hospital transport models on scene-to-CT time, scene-to-surgery time, and complication rates in TICH patients. METHODS: This retrospective cohort study analyzed patients treated by the pre-hospital emergency system between January 2023 and June 2025. Patients were divided into a control group (traditional workflow, January 2023 - February 2024) and an optimization group (post-implementation of standardized triage, direct imaging access, and wireless remote command, March 2024-June 2025). Primary outcomes were scene-to-CT time and scene-to-surgery time. Secondary outcomes included early complications (hypotension, hypoxemia, rebleeding, and transport-related hypothermia). Advanced hypothesis testing analyses included multivariable logistic regression and Cox Proportional Hazards models. RESULTS: The study included 223 TICH patients. The optimization group showed significantly reduced scene-to-CT time [from 52 (IQR 44-63) to 37 (IQR 31-45) minutes, p < 0.001] and scene-to-surgery time [from 89 (IQR 76-108) to 67 (IQR 56-82) minutes, p < 0.001]. Cox regression analysis indicated that the optimization group had a significantly higher likelihood of receiving definitive treatment (adjusted HR 2.14, 95% CI 1.58-2.90). Treatment-related complications decreased significantly, with hypothermia rates reducing from 21 (18.6%) to 8 (7.3%) and hypoxemia from 17 (15.0%) to 6 (5.5%). Multivariable logistic regression confirmed that workflow optimization was independently associated with reduced odds of complications (adjusted OR 0.44, 95% CI 0.24-0.79). CONCLUSION: Pre-hospital workflow optimization, specifically incorporating rapid dispatch protocols, direct transport to neurosurgical-capable facilities, wireless telemedicine consultation, and standardized point-of-care resuscitation, significantly reduced the time from scene to surgery and improved rescue efficiency while decreasing complication rates in TICH patients. These improvements suggest that systematic integration of evidence-based pre-hospital interventions represents a feasible and essential strategy for regional trauma networks.