Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort
Craig D Newgard, Robert H Schmicker, Jerris R Hedges, John P Trickett, Daniel P Davis, Eileen M Bulger, Tom P Aufderheide, Joseph P Minei, J Steven Hata, K Dean Gubler, Todd B Brown, Jean-Denis Yelle, Berit Bardarson, Graham Nichol, Resuscitation Outcomes Consortium Investigators, Jeffrey D Kerby, Todd B Brown, Thomas Terndrup, Joe E Acker, Michael L Minor, Paul A MacLennan, Patrick R Pritchard, Sandra Caldwell, Katherine R Lai, Ahamed H Idris, Fernando Benitez, Raymond Fowler, Dorothy Lemecha, Joseph Minei, Paul Pepe, Michael Ramsay, Robert Simonson, Jane Wigginton, Richard Black, Debra Cason, Billy Craft, Lucy Detamble, Ryan Dykes, Tony Harvey, Suzanne Hewitt, Marshal Isaacs, Joe Kay, Tami Kayea, Richard LaChance, Thomas Lehman, Paul Mayer, Jeffrey Metzger, Danny Miller, Kenneth Navarro, Steven Parker, Karen Pickard, Warren Porter, T J Starling, Tommy Tine, Chris Vinson, David Abebefe, Steven Arze, Sean Black, Matthew Bush, Michael Forman, Jeffery Goodloe, Ralph Kelly, Gregory Lachar, Alicia Mangram, Marc Morales, Edward Thornton, Robert Wiebe, Richard Kerber, Steve Hata, Dianne Atkins, Tom P Aufderheide, Ronald G Pirrallo, Karen J Brasel, Andrea L Winthrop, John P Klein, John Chianelli, Rosemarie Forster, Michael Milbrath, Lauryl Pukansky, Kenneth Sternig, Eugene Chin, Nancy Frieberg, Kim Krueger, Del Szewczuga, Thomas Duerr, Rebecca Funk, Gail Jacobsen, Janis Spitzer, Richard Demien, James Martins, John Cohn, Russell R Spahn, Mike Jankowski, Timothy James, William E Wentlandt Jr, David Berousek, Brian M Satula, Jay B Behling, Dean K Redman, Steven Hook, Andrew Neargarder, Jim Singer, Thomas Reminga, Dennis Shepherd, Peter Holzhauer, Jonathan Rubin, Craig Skold, Orlando Alvarez, Heidi Harkins, Edward Barthell, William Haselow, Albert Yee, John Whitcomb, Eduardo E Castro, Steven Motarjeme, Ian Stiell, Jim Christenson, Morad Hameed, Jean Denis Yelle, Martin Osmond, Christian Vaillancourt, David Evans, Riyad Abu-Laban, Matthew Stempien, Jonathan Dreyer, Douglas Munkley, Justin Maloney, Paul Colella, Andrew Affleck, David Waldbillig, Paul Bradford, Martin Lees, Vincent Arcieri, Ann Wilson, Kenneth Boyle, Lorraine Luinstra-Toohey, John Trickett, Nicole Sykes, Elaine Graham, Kieran Ballah, Cathy Hedges, Paul Mathers, Dug Andrusiek, Dan Bishop, Ron Straight, Brian Twaites, Stuart Donn, Clifton Callaway, Samuel Tisherman, Jon Rittenberger, David Hostler, Paul Sabol, Gina Sicchitano, Scott Sherry, Anthony Shrader, Greg Stull, Manuel Torres, William Groft, Robert McCaughan, Rodney Rohrer, John Cole, David Fuchs, Francis Guyette, William Jenkins, Ronald Roth, Heather Walker, Alain Corcos, Ankur Doshi, Adrian Ong, Andrew Peitzman, Jerris R Hedges, Craig D Newgard, Mohamud R Daya, Robert A Lowe, Jonathan Jui, Terri A Schmidt, Ritu Sahni, Craig R Warden, Marc D Muhr, John A Stouffer, Kyle Gorman, Pontine Rosteck, Karl Koenig, Jan Lee, Roxy Barnes, Heather Tucker, Brad Allen, T J Bishop, Adam Glaser, Martin A Schreiber, Jim Anderson, Ameen I Ramzy, Dean Gubler, Lynn K Wittwer, Samantha Underwood, Brooke Barone, Denise Haun-Taylor, Elizabeth Bryant, Joanne Miller, Daniel Davis, David Hoyt, Raul Coimbra, Gary Vilke, Bruce Haynes, Brad Schwartz, Michael Sise, Frank Kennedy, Fred Smino, Gail Tominaga, John Steele, Peter J Kudenchuk, Tom D Rea, Eileen Bulger, Mickey S Eisenberg, Michael Copass, Earl Sodeman, Marty LaFave, James Boehl, Dave Jones, Gary Somers, Deborah Ayrs, Adrian Whorton, Sam Warren, Jim Fogarty, Jonathan Larsen, Mike Helbock, Arthur Slutsky, Laurie Morrison, Paul Dorian, Dana Bradshaw, Rob Burgess, Bruce Cameron, Sandra Chad, Sheldon Cheskes, Allan Craig, Steve Dewar, Tim Dodd, Rob Duquette, Marty Epp, Michael Feldman, Verena Jones, Russell MacDonald, Larry MacLay, Steve McNenley, Judy Moore, Philip Moran, Michael Murray, Michael Nemeth, Russ Olnyk, Tyrone Perreira, Richard Renaud, Karen Roche, Jennifer Shield, Doug Silver, Jacob Stevens, Rick Verbeek, Tim Waite, Ken Webb, Michelle Welsford, Rosemarie Farrell, Jamie Hutchinson, Myron Weisfeldt, Joseph P Ornato, David B Hoyt, John B Holcomb, Tracey Hoke, George Sopko, David Lathrop, Alice Mascette, Patrice Desvigne Nickens, Al Hallstrom, Graham Nichol, Scott Emerson, Judy Powell, Gena Sears, Berit Bardarson, Lois Van Ottingham, Anna Leonen, Robert B Ledingham, Chris Finley, Richard Moore, Ben Bergsten-Buret, Craig D Newgard, Robert H Schmicker, Jerris R Hedges, John P Trickett, Daniel P Davis, Eileen M Bulger, Tom P Aufderheide, Joseph P Minei, J Steven Hata, K Dean Gubler, Todd B Brown, Jean-Denis Yelle, Berit Bardarson, Graham Nichol, Resuscitation Outcomes Consortium Investigators, Jeffrey D Kerby, Todd B Brown, Thomas Terndrup, Joe E Acker, Michael L Minor, Paul A MacLennan, Patrick R Pritchard, Sandra Caldwell, Katherine R Lai, Ahamed H Idris, Fernando Benitez, Raymond Fowler, Dorothy Lemecha, Joseph Minei, Paul Pepe, Michael Ramsay, Robert Simonson, Jane Wigginton, Richard Black, Debra Cason, Billy Craft, Lucy Detamble, Ryan Dykes, Tony Harvey, Suzanne Hewitt, Marshal Isaacs, Joe Kay, Tami Kayea, Richard LaChance, Thomas Lehman, Paul Mayer, Jeffrey Metzger, Danny Miller, Kenneth Navarro, Steven Parker, Karen Pickard, Warren Porter, T J Starling, Tommy Tine, Chris Vinson, David Abebefe, Steven Arze, Sean Black, Matthew Bush, Michael Forman, Jeffery Goodloe, Ralph Kelly, Gregory Lachar, Alicia Mangram, Marc Morales, Edward Thornton, Robert Wiebe, Richard Kerber, Steve Hata, Dianne Atkins, Tom P Aufderheide, Ronald G Pirrallo, Karen J Brasel, Andrea L Winthrop, John P Klein, John Chianelli, Rosemarie Forster, Michael Milbrath, Lauryl Pukansky, Kenneth Sternig, Eugene Chin, Nancy Frieberg, Kim Krueger, Del Szewczuga, Thomas Duerr, Rebecca Funk, Gail Jacobsen, Janis Spitzer, Richard Demien, James Martins, John Cohn, Russell R Spahn, Mike Jankowski, Timothy James, William E Wentlandt Jr, David Berousek, Brian M Satula, Jay B Behling, Dean K Redman, Steven Hook, Andrew Neargarder, Jim Singer, Thomas Reminga, Dennis Shepherd, Peter Holzhauer, Jonathan Rubin, Craig Skold, Orlando Alvarez, Heidi Harkins, Edward Barthell, William Haselow, Albert Yee, John Whitcomb, Eduardo E Castro, Steven Motarjeme, Ian Stiell, Jim Christenson, Morad Hameed, Jean Denis Yelle, Martin Osmond, Christian Vaillancourt, David Evans, Riyad Abu-Laban, Matthew Stempien, Jonathan Dreyer, Douglas Munkley, Justin Maloney, Paul Colella, Andrew Affleck, David Waldbillig, Paul Bradford, Martin Lees, Vincent Arcieri, Ann Wilson, Kenneth Boyle, Lorraine Luinstra-Toohey, John Trickett, Nicole Sykes, Elaine Graham, Kieran Ballah, Cathy Hedges, Paul Mathers, Dug Andrusiek, Dan Bishop, Ron Straight, Brian Twaites, Stuart Donn, Clifton Callaway, Samuel Tisherman, Jon Rittenberger, David Hostler, Paul Sabol, Gina Sicchitano, Scott Sherry, Anthony Shrader, Greg Stull, Manuel Torres, William Groft, Robert McCaughan, Rodney Rohrer, John Cole, David Fuchs, Francis Guyette, William Jenkins, Ronald Roth, Heather Walker, Alain Corcos, Ankur Doshi, Adrian Ong, Andrew Peitzman, Jerris R Hedges, Craig D Newgard, Mohamud R Daya, Robert A Lowe, Jonathan Jui, Terri A Schmidt, Ritu Sahni, Craig R Warden, Marc D Muhr, John A Stouffer, Kyle Gorman, Pontine Rosteck, Karl Koenig, Jan Lee, Roxy Barnes, Heather Tucker, Brad Allen, T J Bishop, Adam Glaser, Martin A Schreiber, Jim Anderson, Ameen I Ramzy, Dean Gubler, Lynn K Wittwer, Samantha Underwood, Brooke Barone, Denise Haun-Taylor, Elizabeth Bryant, Joanne Miller, Daniel Davis, David Hoyt, Raul Coimbra, Gary Vilke, Bruce Haynes, Brad Schwartz, Michael Sise, Frank Kennedy, Fred Smino, Gail Tominaga, John Steele, Peter J Kudenchuk, Tom D Rea, Eileen Bulger, Mickey S Eisenberg, Michael Copass, Earl Sodeman, Marty LaFave, James Boehl, Dave Jones, Gary Somers, Deborah Ayrs, Adrian Whorton, Sam Warren, Jim Fogarty, Jonathan Larsen, Mike Helbock, Arthur Slutsky, Laurie Morrison, Paul Dorian, Dana Bradshaw, Rob Burgess, Bruce Cameron, Sandra Chad, Sheldon Cheskes, Allan Craig, Steve Dewar, Tim Dodd, Rob Duquette, Marty Epp, Michael Feldman, Verena Jones, Russell MacDonald, Larry MacLay, Steve McNenley, Judy Moore, Philip Moran, Michael Murray, Michael Nemeth, Russ Olnyk, Tyrone Perreira, Richard Renaud, Karen Roche, Jennifer Shield, Doug Silver, Jacob Stevens, Rick Verbeek, Tim Waite, Ken Webb, Michelle Welsford, Rosemarie Farrell, Jamie Hutchinson, Myron Weisfeldt, Joseph P Ornato, David B Hoyt, John B Holcomb, Tracey Hoke, George Sopko, David Lathrop, Alice Mascette, Patrice Desvigne Nickens, Al Hallstrom, Graham Nichol, Scott Emerson, Judy Powell, Gena Sears, Berit Bardarson, Lois Van Ottingham, Anna Leonen, Robert B Ledingham, Chris Finley, Richard Moore, Ben Bergsten-Buret
Abstract
Study objective: The first hour after the onset of out-of-hospital traumatic injury is referred to as the "golden hour," yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality.
Methods: This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged > or =15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007. Inclusion criteria were systolic blood pressure less than or equal to 90 mm Hg, respiratory rate less than 10 or greater than 29 breaths/min, Glasgow Coma Scale score less than or equal to 12, or advanced airway intervention. The outcome was in-hospital mortality. We evaluated EMS intervals (activation, response, on-scene, transport, and total time) with logistic regression and 2-step instrumental variable models, adjusted for field-based confounders.
Results: There were 3,656 trauma patients available for analysis, of whom 806 (22.0%) died. In multivariable analyses, there was no significant association between time and mortality for any EMS interval: activation (odds ratio [OR] 1.00; 95% confidence interval [CI] 0.95 to 1.05), response (OR 1.00; 95% CI 9.97 to 1.04), on-scene (OR 1.00; 95% CI 0.99 to 1.01), transport (OR 1.00; 95% CI 0.98 to 1.01), or total EMS time (OR 1.00; 95% CI 0.99 to 1.01). Subgroup and instrumental variable analyses did not qualitatively change these findings.
Conclusion: In this North American sample, there was no association between EMS intervals and mortality among injured patients with physiologic abnormality in the field.
Copyright (c) 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
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Source: PubMed