Highlights
- •Risk of death increased with longer prehospital times, most prominent within the first 30 min.
- •Mortality risk was more significant with higher Torso Abbreviated Injury Scale (AIS) scores.
- •Need to develop strategies to increase the window of survival in the prehospital environment.
Abstract
Introduction
The concept of the “Golden Hour” has been a time-honored tenet of prehospital trauma
care, despite a paucity of data to substantiate its validity. Non-compressible torso
hemorrhage has been demonstrated to be a significant cause of mortality in both military
and civilian settings. We sought to characterize the impact of prehospital time and
torso injury severity on survival. Furthermore, we hypothesized that time would be
a significant determinant of mortality in patients with higher Abbreviated Injury
Scale (AIS) grades of torso injury (AIS ≥ 4) and field hypotension (prehospital SBP ≤ 110 mmHg)
as these injuries are commonly associated with hemorrhage.
Methods
Data for this analysis was generated from a registry of 2,523,394 injured patients
entered into the National Trauma Data Bank Research Data Set from 2012 to 2014. Patients
with torso injury were identified utilizing Abbreviated Injury Scale (AIS) for body
regions 4 (Thorax) and 5 (Abdomen). Specific inclusion criteria for this study included
pre-hospital time, prehospital SBP ≤110 mmHg, torso injury qualified by AIS and mortality.
Patients with non-survivable torso injury (AIS = 6), severe head injuries (AIS ≥ 3),
no signs of life in the field (SBP = 0), interfacility transfers, or those with any
missing data elements were excluded. This classification methodology identified a
composite cohort of 42,135 adult patients for analysis.
Results
The overall mortality rate of the study population was 7.9% (3326/42,135); Torso AIS
and prehospital time were noted to be strong independent predictors of patient mortality
in all population strata of the analysis (P < 0.05). The data demonstrated a profound
incremental increase in mortality in the early time course after injury associated
with torso AIS ≥4.
Conclusion
In patients with high-grade torso injury, AIS grades ≥4, the degree anatomic disruption
is associated with significant hemorrhage. In our study, a precipitous rise in patient
mortality was exhibited in this high-grade injury group at prehospital times <30 min.
Our data highlight the critical nature of prehospital time in patients with non-compressible
torso hemorrhage. However, realizing that evacuation times ≤30 min may not be realistic,
particularly in rural or austere environments, future efforts should be directed toward
the development of therapies to increase the window of survival in the prehospital
environment.
Keywords
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Article info
Publication history
Published online: October 20, 2016
Accepted:
August 24,
2016
Received:
March 30,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
