Trauma: Should You Stay or Should You Go?

WASHINGTON-The results of a 14-year study of trauma patients brought to a level I trauma center come close to settling the debate over the "load and go" versus "stay and stabilize" approach to patient care in the out-of-hospital setting: the answer depends on whether the injuries are penetrating or blunt ("Emergency Medical Services Out-of-Hospital Scene and Transport Times and Their Association with Mortality in Trauma Patients Presenting to an Urban Level I Trauma Center").

The study—the first of its kind to analyze data spanning more than a decade—was published recently in Annals of Emergency Medicine.

"We observed an association between longer out-of-hospital times, in particular scene times, and mortality in patients with penetrating trauma," said lead study author C. Eric McCoy, MD, MPH, of the University of California Irvine School of Medicine in Orange, Calif. "Given the challenges of providing out-of-hospital care to heterogeneous populations through a heterogeneous delivery system, it is imperative that the medical community identify patients who may benefit from timely care before abandoning the notion that faster is better for all patients in the out-of-hospital setting."

Researchers analyzed records for 19,167 trauma patients. Eighty-four percent of the injuries were blunt and 16 percent were penetrating. For patients with penetrating trauma, higher odds of mortality were observed when treatment delivered at the scene exceeded 20 minutes. Longer transport times were not associated with increased odds of mortality in patients with penetrating trauma. For patients with blunt trauma, there was no association between scene or transport times and increased odds of mortality.

"Our findings support the 'golden hour' concept of trauma care and are consistent with the previously demonstrated hospital-based beneficial effect on survival," said Dr. McCoy. "Our study also supports the conclusion that even if transport time is longer because of geographical distance from the scene to a trauma center, seriously injured patients benefit by being transported to trauma centers for hospital-based care."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.

 

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