Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

• DOI: 10.1186/cc9982
• Publication Date: 2011-03-04T19:14:01Z
• Authors: Jean-Michel Yegui...; Delphine Garrigue; Christine Binquet; Claude Jacquot; Jacques Duranteau; Claude Martin; Fatima Rayeh; Bruno Riou; Claire Bonithon-Kopp; Marc Freysz
• Keywords: Adult; Male; Emergency Medical Services; Time Factors; Adolescent; [SHS.INFO]Humanities and Social Sciences/Library and information sciences; MESH: Injury Severity Score; 610; Critical Care and Intensive Care Medicine; [SHS.INFO] Humanities and Social Sciences/Library and information sciences; Young Adult; 03 medical and health sciences; Injury Severity Score; Patient Admission; 0302 clinical medicine; Humans; MESH: Hospital Mortality; Hospital Mortality; Prospective Studies; MESH: Treatment Outcome; Aged; MESH: Adolescent; MESH: Aged; MESH: Humans; MESH: Middle Aged; MESH: Patient Admission; Research; MESH: Time Factors; MESH: Adult; Middle Aged; MESH: Male; MESH: Prospective Studies; 3. Good health; MESH: France; Intensive Care Units; Treatment Outcome; MESH: Wounds and Injuries; MESH: Young Adult; [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie; Firefighters; MESH: Emergency Medical Services; Blunt trauma; Wounds and Injuries; MESH: Intensive Care Units; [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie; France; MESH: Firefighters

Abstract Introduction Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality.

Methods The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality.

Results Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results.

Conclusions This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.