TY - JOUR
T1 - A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes
AU - Bedard, Alexander F.
AU - Mata, Lina V.
AU - Dymond, Chelsea
AU - Moreira, Fabio
AU - Dixon, Julia
AU - Schauer, Steven G.
AU - Ginde, Adit A.
AU - Bebarta, Vikhyat
AU - Moore, Ernest E.
AU - Mould-Millman, Nee Kofi
N1 - Funding Information:
Funding for this study was provided by a US Department of Defense grant (#W81XWH1920055) awarded for a larger study investigating prolonged prehospital trauma care and resultant outcomes. Funding was used to pay a librarian for services rendered in the search for articles for review and to pay for article submission.
Funding Information:
The authors would like to thank their friends and family for their support given the difficulty facing all of us during the COVID-19 pandemic. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Army Medical Department, Air Force Medical Service, Department of the Army, Department of the Air Force, Department of Defense, or the US Government.
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - Background: Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation. Main body: We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure. Conclusion: The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.
AB - Background: Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation. Main body: We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure. Conclusion: The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.
KW - Emergency medical services
KW - Prehospital time
KW - Trauma
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U2 - 10.1186/s12245-020-00324-7
DO - 10.1186/s12245-020-00324-7
M3 - Review article
AN - SCOPUS:85097380613
VL - 13
JO - International Journal of Emergency Medicine
JF - International Journal of Emergency Medicine
SN - 1865-1372
IS - 1
M1 - 64
ER -