Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study

PLoS Med. 2020 Oct 6;17(10):e1003360. doi: 10.1371/journal.pmed.1003360. eCollection 2020 Oct.

Abstract

Background: Whether rapid transportation can benefit patients with trauma remains controversial. We determined the association between prehospital time and outcome to explore the concept of the "golden hour" for injured patients.

Methods and findings: We conducted a retrospective cohort study of trauma patients transported from the scene to hospitals by emergency medical service (EMS) from January 1, 2016, to November 30, 2018, using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time intervals were categorized into response time (RT), scene to hospital time (SH), and total prehospital time (TPT). The outcomes were 30-day mortality and functional status at hospital discharge. Multivariable logistic regression was used to investigate the association of prehospital time and outcomes to adjust for factors including age, sex, mechanism and type of injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and prehospital interventions. Overall, 24,365 patients from 4 countries (645 patients from Japan, 16,476 patients from Korea, 5,358 patients from Malaysia, and 1,886 patients from Taiwan) were included in the analysis. Among included patients, the median age was 45 years (lower quartile [Q1]-upper quartile [Q3]: 25-62), and 15,498 (63.6%) patients were male. Median (Q1-Q3) RT, SH, and TPT were 20 (Q1-Q3: 12-39), 21 (Q1-Q3: 16-29), and 47 (Q1-Q3: 32-60) minutes, respectively. In all, 280 patients (1.1%) died within 30 days after injury. Prehospital time intervals were not associated with 30-day mortality. The adjusted odds ratios (aORs) per 10 minutes of RT, SH, and TPT were 0.99 (95% CI 0.92-1.06, p = 0.740), 1.08 (95% CI 1.00-1.17, p = 0.065), and 1.03 (95% CI 0.98-1.09, p = 0.236), respectively. However, long prehospital time was detrimental to functional survival. The aORs of RT, SH, and TPT per 10-minute delay were 1.06 (95% CI 1.04-1.08, p < 0.001), 1.05 (95% CI 1.01-1.08, p = 0.007), and 1.06 (95% CI 1.04-1.08, p < 0.001), respectively. The key limitation of our study is the missing data inherent to the retrospective design. Another major limitation is the aggregate nature of the data from different countries and unaccounted confounders such as in-hospital management.

Conclusions: Longer prehospital time was not associated with an increased risk of 30-day mortality, but it may be associated with increased risk of poor functional outcomes in injured patients. This finding supports the concept of the "golden hour" for trauma patients during prehospital care in the countries studied.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Emergency Medical Services / organization & administration
  • Emergency Service, Hospital / organization & administration
  • Female
  • Hospital Mortality
  • Hospitals
  • Humans
  • Injury Severity Score
  • Japan
  • Logistic Models
  • Malaysia
  • Male
  • Middle Aged
  • Odds Ratio
  • Registries
  • Republic of Korea
  • Retrospective Studies
  • Taiwan
  • Time Factors
  • Time-to-Treatment / statistics & numerical data*
  • Transportation of Patients / statistics & numerical data*
  • Trauma Centers
  • Wounds and Injuries / therapy

Grants and funding

This study was funded by the Taiwan Ministry of Science and Technology (MOST 108-2314-B-002-130-MY3 and MOST 105-2314-B-002-200-MY3 and MOST 109-2314-B-002 -154 -MY2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.