Time Spent at the Trauma Scene Found Unrelated to Mortality Risk

Contrary to common belief, the time a trauma victim spends on the scene of the accident does not predict mortality once they are taken to a trauma center, according to a new study.

Researchers at the Ohio State University Medical Center (Columbus, OH, USA) conducted a retrospective observational cohort study to determine whether scene time had an effect on mortality in injured patients transported directly from the accident scene by ground or by air to the trauma center in a large metropolitan area between January 2001 and December 2006. A total of 4,461 aged 15 years or older who were admitted for at least two days or who died before two days had passed were included in the analysis; the location of the injury was not accounted for. Furthermore, although some of these patients might have had a myocardial infarction (MI), such information was not obtained nor included in the analysis, nor did the researchers include transferred trauma patients or patients arriving by private transportation. A multivariate logistic regression analysis was developed for scene time and mortality to see if there was any association, with adjustments for factors such as age, mode of transportation, and severity of injury. Injury severity score (ISS) and revised trauma score were also obtained.

The study results showed that of the total patient group, 59% were transported by air. The median ISS was 10, and overall mortality was 5.2%. Mean scene time did not differ between survivors (14.4 minutes) and non-survivors (15.3 minutes). In the final analysis, scene time was the only factor that had no association with mortality. This lack of association remained when patients were stratified by those who had been intubated before arriving at the hospital and those who had not. Even for patients with a scene time longer than the mean, there was no observable increase in mortality. In addition, no increase in mortality was seen when patients were stratified by ground transport versus air transport, blunt versus penetrating trauma, Glasgow Coma Scale score less than 9 versus 9 or higher, and by those with an out-of-hospital systolic blood pressure of less than 90 mmHg versus 90 mmHg or more. The study was presented at the American College of Emergency Physicians (ACEP) scientific assembly, held during October 2008 in Chicago (IL, USA).

"Emergency medicine physicians have always believed that the ‘golden hour' of care was the most important factor for trauma-patient outcomes. However, there are no real data to support this theory,” said lead author Michael Cudnik, M.D., an associate professor in the department of emergency medicine.

"I find it a little surprising that scene time was not associated with a higher mortality. Throughout emergency medicine, we are taught how important it is to reach the medical center quickly,” said Nolan McMullin, M.D., a staff emergency physician at the Cleveland Clinic (Ohio, USA) who heard the presentation.

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