Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/30895
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Prehospital critical care is associated with increased survival in adult trauma patients in Scotland
Author(s): Maddock, Alistair
Corfield, Alasdair R
Donald, Michael J
Lyon, Richard M
Sinclair, Neil
Fitzpatrick, David
Carr, David
Hearns, Stephen
Keywords: Critical Care and Intensive Care Medicine
Emergency Medicine
General Medicine
Issue Date: Mar-2020
Citation: Maddock A, Corfield AR, Donald MJ, Lyon RM, Sinclair N, Fitzpatrick D, Carr D & Hearns S (2020) Prehospital critical care is associated with increased survival in adult trauma patients in Scotland. Emergency Medicine Journal, 37 (3), pp. 141-145. https://doi.org/10.1136/emermed-2019-208458
Abstract: Background Scotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally. Methods National registry-based retrospective cohort study using 2011-2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables. Results Our data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p < 0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01). Conclusion Prehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.
DOI Link: 10.1136/emermed-2019-208458
Rights: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Licence URL(s): http://creativecommons.org/licenses/by-nc/4.0/

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