The effect of prehospital time related variables on mortality following severe thoracic trauma
Abstract Objectives The aims of this study is firstly to analyse the impact of prehospital time related variables on mortality, in a specific subset of HEMS patients and secondly to demonstrate any interactions between time related variables and factors taking place in the prehospital setting. Metho...
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| Veröffentlicht in: | Injury 2012-09, Vol.43 (9), p.1386-1392 |
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| creator | Kidher, Emaddin Krasopoulos, George Coats, Tim Charitou, Alexandros Magee, Patrick Uppal, Rakesh Athanasiou, Thanos |
| description | Abstract Objectives The aims of this study is firstly to analyse the impact of prehospital time related variables on mortality, in a specific subset of HEMS patients and secondly to demonstrate any interactions between time related variables and factors taking place in the prehospital setting. Methods Retrospective analysis of 688 consecutive London HEMS transfers with severe thoracic trauma and mean injury severity score (ISS) of 35, during a 9-year period (1994–2002). We have analysed the effect of the following time related variables on mortality: activation time, arrival on scene time (AoS), stay on scene time (SoS), total time (ToT), rush-hour time (RhT) and leisure-hour time (LhT). We have also investigated the interaction of the above mentioned variables with observations and interventions taken place on scene and at accident and emergency department (A&E) following adjustment for type and severity of injury. For statistical analysis the time variables were grouped into quintiles. Results Six hundred eighty eight victims (510 males) with mean age of 38.5 ± 17.5 had total survival rate of 59.6%. The mean AoS and SoS were 11.6 ± 5.8 min and 36.6 ± 16.8 min, respectively. ToT > 65 min, as in quintiles III, IV and V with mean ToT of 65.3 min, 74.9 min and 102.7 min respectively, had an influence on mortality with calculated adjusted OR of 1.37 (95%CI = 0.47–3.94), 3.36 (95%CI = 1.22–9.23) and 1.43 (95%CI = 0.52–3.92) respectively with concomitant adjustment for type of injury, severity of injury, age, physiological variables on scene and on scene emergency thoracotomy (ET). ET on scene was an independent predictor for mortality (OR 3.94, 95%CI = 1.03–15.06). SoS of more than 34 min can lead to harmful changes on patients’ pathophysiological status. ISS has no significant effect on AoS or SoS. RhT and LhT have no significant effect on mortality and they did not influence the AoS and SoS. Conclusion This study suggests that time related variables have a complex and heterogeneous effect on mortality. Thoracic trauma victims usually have high ISS, in such population, ToT |
| doi_str_mv | 10.1016/j.injury.2011.04.014 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1027682733</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S002013831100177X</els_id><sourcerecordid>1027682733</sourcerecordid><originalsourceid>FETCH-LOGICAL-c417t-b1addb912b5cb67c98fe1c78d7861ac968b973fb30bf9c3d82172bdc2ae7ac4a3</originalsourceid><addsrcrecordid>eNqFkT2P1DAQhi0E4paDf4CQS5oEj52NkwYJnfiSTqLgkKiw_DFmHZx4sZNF--9JtAcFDdU0z7yjeV5CngOrgUH7aqjDNCz5XHMGULOmZtA8IDvoZF8x3sqHZMcYZxWITlyRJ6UMjIFkQjwmVxz27V40Yke-3R2QovdoZ5o8PWY8pHIMs450DiPSjFHP6OhJ56BNxELTRMeUVyDMZ-pTjOlXmL7TgifMSOdDytoGS-esl1E_JY-8jgWf3c9r8uXd27ubD9Xtp_cfb97cVrYBOVcGtHOmB2721rTS9p1HsLJzsmtB277tTC-FN4IZ31vhOg6SG2e5Rqlto8U1eXnJPeb0c8EyqzEUizHqCdNSFDAu245LIVa0uaA2p1IyenXMYdT5vEJqM6sGdTGrNrOKNWo1u669uL-wmBHd36U_Klfg9QXA9c9TwKyKDThZdCGvdpVL4X8X_g2wMUzB6vgDz1iGtORpdahAFa6Y-ry1u5ULsBUrv4rf9e2jLw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1027682733</pqid></control><display><type>article</type><title>The effect of prehospital time related variables on mortality following severe thoracic trauma</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Kidher, Emaddin ; Krasopoulos, George ; Coats, Tim ; Charitou, Alexandros ; Magee, Patrick ; Uppal, Rakesh ; Athanasiou, Thanos</creator><creatorcontrib>Kidher, Emaddin ; Krasopoulos, George ; Coats, Tim ; Charitou, Alexandros ; Magee, Patrick ; Uppal, Rakesh ; Athanasiou, Thanos</creatorcontrib><description>Abstract Objectives The aims of this study is firstly to analyse the impact of prehospital time related variables on mortality, in a specific subset of HEMS patients and secondly to demonstrate any interactions between time related variables and factors taking place in the prehospital setting. Methods Retrospective analysis of 688 consecutive London HEMS transfers with severe thoracic trauma and mean injury severity score (ISS) of 35, during a 9-year period (1994–2002). We have analysed the effect of the following time related variables on mortality: activation time, arrival on scene time (AoS), stay on scene time (SoS), total time (ToT), rush-hour time (RhT) and leisure-hour time (LhT). We have also investigated the interaction of the above mentioned variables with observations and interventions taken place on scene and at accident and emergency department (A&E) following adjustment for type and severity of injury. For statistical analysis the time variables were grouped into quintiles. Results Six hundred eighty eight victims (510 males) with mean age of 38.5 ± 17.5 had total survival rate of 59.6%. The mean AoS and SoS were 11.6 ± 5.8 min and 36.6 ± 16.8 min, respectively. ToT > 65 min, as in quintiles III, IV and V with mean ToT of 65.3 min, 74.9 min and 102.7 min respectively, had an influence on mortality with calculated adjusted OR of 1.37 (95%CI = 0.47–3.94), 3.36 (95%CI = 1.22–9.23) and 1.43 (95%CI = 0.52–3.92) respectively with concomitant adjustment for type of injury, severity of injury, age, physiological variables on scene and on scene emergency thoracotomy (ET). ET on scene was an independent predictor for mortality (OR 3.94, 95%CI = 1.03–15.06). SoS of more than 34 min can lead to harmful changes on patients’ pathophysiological status. ISS has no significant effect on AoS or SoS. RhT and LhT have no significant effect on mortality and they did not influence the AoS and SoS. Conclusion This study suggests that time related variables have a complex and heterogeneous effect on mortality. Thoracic trauma victims usually have high ISS, in such population, ToT <65 min may be associated with lower possibility of death. Neither AoS nor SoS was influenced by time of incident or severity of injury.</description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2011.04.014</identifier><identifier>PMID: 21565343</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adult ; Algorithms ; Chest injury ; Emergency Medical Services - organization & administration ; Emergency thoracotomy and Helicopter Emergency Medical Service HEMS ; Emergency Treatment - statistics & numerical data ; Female ; Humans ; Injury Severity Score ; London - epidemiology ; Male ; Middle Aged ; Orthopedics ; Prehospital time ; Retrospective Studies ; Survival Rate ; Thoracic Injuries - mortality ; Thoracic Injuries - physiopathology ; Thoracic Injuries - surgery ; Thoracic trauma ; Thoracotomy - mortality ; Thoracotomy - statistics & numerical data ; Time Factors</subject><ispartof>Injury, 2012-09, Vol.43 (9), p.1386-1392</ispartof><rights>Elsevier Ltd</rights><rights>2011 Elsevier Ltd</rights><rights>Copyright © 2011 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-b1addb912b5cb67c98fe1c78d7861ac968b973fb30bf9c3d82172bdc2ae7ac4a3</citedby><cites>FETCH-LOGICAL-c417t-b1addb912b5cb67c98fe1c78d7861ac968b973fb30bf9c3d82172bdc2ae7ac4a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.injury.2011.04.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3538,27906,27907,45977</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21565343$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kidher, Emaddin</creatorcontrib><creatorcontrib>Krasopoulos, George</creatorcontrib><creatorcontrib>Coats, Tim</creatorcontrib><creatorcontrib>Charitou, Alexandros</creatorcontrib><creatorcontrib>Magee, Patrick</creatorcontrib><creatorcontrib>Uppal, Rakesh</creatorcontrib><creatorcontrib>Athanasiou, Thanos</creatorcontrib><title>The effect of prehospital time related variables on mortality following severe thoracic trauma</title><title>Injury</title><addtitle>Injury</addtitle><description>Abstract Objectives The aims of this study is firstly to analyse the impact of prehospital time related variables on mortality, in a specific subset of HEMS patients and secondly to demonstrate any interactions between time related variables and factors taking place in the prehospital setting. Methods Retrospective analysis of 688 consecutive London HEMS transfers with severe thoracic trauma and mean injury severity score (ISS) of 35, during a 9-year period (1994–2002). We have analysed the effect of the following time related variables on mortality: activation time, arrival on scene time (AoS), stay on scene time (SoS), total time (ToT), rush-hour time (RhT) and leisure-hour time (LhT). We have also investigated the interaction of the above mentioned variables with observations and interventions taken place on scene and at accident and emergency department (A&E) following adjustment for type and severity of injury. For statistical analysis the time variables were grouped into quintiles. Results Six hundred eighty eight victims (510 males) with mean age of 38.5 ± 17.5 had total survival rate of 59.6%. The mean AoS and SoS were 11.6 ± 5.8 min and 36.6 ± 16.8 min, respectively. ToT > 65 min, as in quintiles III, IV and V with mean ToT of 65.3 min, 74.9 min and 102.7 min respectively, had an influence on mortality with calculated adjusted OR of 1.37 (95%CI = 0.47–3.94), 3.36 (95%CI = 1.22–9.23) and 1.43 (95%CI = 0.52–3.92) respectively with concomitant adjustment for type of injury, severity of injury, age, physiological variables on scene and on scene emergency thoracotomy (ET). ET on scene was an independent predictor for mortality (OR 3.94, 95%CI = 1.03–15.06). SoS of more than 34 min can lead to harmful changes on patients’ pathophysiological status. ISS has no significant effect on AoS or SoS. RhT and LhT have no significant effect on mortality and they did not influence the AoS and SoS. Conclusion This study suggests that time related variables have a complex and heterogeneous effect on mortality. Thoracic trauma victims usually have high ISS, in such population, ToT <65 min may be associated with lower possibility of death. Neither AoS nor SoS was influenced by time of incident or severity of injury.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Chest injury</subject><subject>Emergency Medical Services - organization & administration</subject><subject>Emergency thoracotomy and Helicopter Emergency Medical Service HEMS</subject><subject>Emergency Treatment - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>London - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Prehospital time</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Thoracic Injuries - mortality</subject><subject>Thoracic Injuries - physiopathology</subject><subject>Thoracic Injuries - surgery</subject><subject>Thoracic trauma</subject><subject>Thoracotomy - mortality</subject><subject>Thoracotomy - statistics & numerical data</subject><subject>Time Factors</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkT2P1DAQhi0E4paDf4CQS5oEj52NkwYJnfiSTqLgkKiw_DFmHZx4sZNF--9JtAcFDdU0z7yjeV5CngOrgUH7aqjDNCz5XHMGULOmZtA8IDvoZF8x3sqHZMcYZxWITlyRJ6UMjIFkQjwmVxz27V40Yke-3R2QovdoZ5o8PWY8pHIMs450DiPSjFHP6OhJ56BNxELTRMeUVyDMZ-pTjOlXmL7TgifMSOdDytoGS-esl1E_JY-8jgWf3c9r8uXd27ubD9Xtp_cfb97cVrYBOVcGtHOmB2721rTS9p1HsLJzsmtB277tTC-FN4IZ31vhOg6SG2e5Rqlto8U1eXnJPeb0c8EyqzEUizHqCdNSFDAu245LIVa0uaA2p1IyenXMYdT5vEJqM6sGdTGrNrOKNWo1u669uL-wmBHd36U_Klfg9QXA9c9TwKyKDThZdCGvdpVL4X8X_g2wMUzB6vgDz1iGtORpdahAFa6Y-ry1u5ULsBUrv4rf9e2jLw</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Kidher, Emaddin</creator><creator>Krasopoulos, George</creator><creator>Coats, Tim</creator><creator>Charitou, Alexandros</creator><creator>Magee, Patrick</creator><creator>Uppal, Rakesh</creator><creator>Athanasiou, Thanos</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>The effect of prehospital time related variables on mortality following severe thoracic trauma</title><author>Kidher, Emaddin ; Krasopoulos, George ; Coats, Tim ; Charitou, Alexandros ; Magee, Patrick ; Uppal, Rakesh ; Athanasiou, Thanos</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-b1addb912b5cb67c98fe1c78d7861ac968b973fb30bf9c3d82172bdc2ae7ac4a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Chest injury</topic><topic>Emergency Medical Services - organization & administration</topic><topic>Emergency thoracotomy and Helicopter Emergency Medical Service HEMS</topic><topic>Emergency Treatment - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>London - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Prehospital time</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Thoracic Injuries - mortality</topic><topic>Thoracic Injuries - physiopathology</topic><topic>Thoracic Injuries - surgery</topic><topic>Thoracic trauma</topic><topic>Thoracotomy - mortality</topic><topic>Thoracotomy - statistics & numerical data</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kidher, Emaddin</creatorcontrib><creatorcontrib>Krasopoulos, George</creatorcontrib><creatorcontrib>Coats, Tim</creatorcontrib><creatorcontrib>Charitou, Alexandros</creatorcontrib><creatorcontrib>Magee, Patrick</creatorcontrib><creatorcontrib>Uppal, Rakesh</creatorcontrib><creatorcontrib>Athanasiou, Thanos</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kidher, Emaddin</au><au>Krasopoulos, George</au><au>Coats, Tim</au><au>Charitou, Alexandros</au><au>Magee, Patrick</au><au>Uppal, Rakesh</au><au>Athanasiou, Thanos</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of prehospital time related variables on mortality following severe thoracic trauma</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>43</volume><issue>9</issue><spage>1386</spage><epage>1392</epage><pages>1386-1392</pages><issn>0020-1383</issn><eissn>1879-0267</eissn><abstract>Abstract Objectives The aims of this study is firstly to analyse the impact of prehospital time related variables on mortality, in a specific subset of HEMS patients and secondly to demonstrate any interactions between time related variables and factors taking place in the prehospital setting. Methods Retrospective analysis of 688 consecutive London HEMS transfers with severe thoracic trauma and mean injury severity score (ISS) of 35, during a 9-year period (1994–2002). We have analysed the effect of the following time related variables on mortality: activation time, arrival on scene time (AoS), stay on scene time (SoS), total time (ToT), rush-hour time (RhT) and leisure-hour time (LhT). We have also investigated the interaction of the above mentioned variables with observations and interventions taken place on scene and at accident and emergency department (A&E) following adjustment for type and severity of injury. For statistical analysis the time variables were grouped into quintiles. Results Six hundred eighty eight victims (510 males) with mean age of 38.5 ± 17.5 had total survival rate of 59.6%. The mean AoS and SoS were 11.6 ± 5.8 min and 36.6 ± 16.8 min, respectively. ToT > 65 min, as in quintiles III, IV and V with mean ToT of 65.3 min, 74.9 min and 102.7 min respectively, had an influence on mortality with calculated adjusted OR of 1.37 (95%CI = 0.47–3.94), 3.36 (95%CI = 1.22–9.23) and 1.43 (95%CI = 0.52–3.92) respectively with concomitant adjustment for type of injury, severity of injury, age, physiological variables on scene and on scene emergency thoracotomy (ET). ET on scene was an independent predictor for mortality (OR 3.94, 95%CI = 1.03–15.06). SoS of more than 34 min can lead to harmful changes on patients’ pathophysiological status. ISS has no significant effect on AoS or SoS. RhT and LhT have no significant effect on mortality and they did not influence the AoS and SoS. Conclusion This study suggests that time related variables have a complex and heterogeneous effect on mortality. Thoracic trauma victims usually have high ISS, in such population, ToT <65 min may be associated with lower possibility of death. Neither AoS nor SoS was influenced by time of incident or severity of injury.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>21565343</pmid><doi>10.1016/j.injury.2011.04.014</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Algorithms Chest injury Emergency Medical Services - organization & administration Emergency thoracotomy and Helicopter Emergency Medical Service HEMS Emergency Treatment - statistics & numerical data Female Humans Injury Severity Score London - epidemiology Male Middle Aged Orthopedics Prehospital time Retrospective Studies Survival Rate Thoracic Injuries - mortality Thoracic Injuries - physiopathology Thoracic Injuries - surgery Thoracic trauma Thoracotomy - mortality Thoracotomy - statistics & numerical data Time Factors |
| title | The effect of prehospital time related variables on mortality following severe thoracic trauma |
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