Efficacy of the presence of an emergency physician in prehospital major trauma care: A nationwide cohort study in Japan |
| |
| Institution: | 1. Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, Japan;2. Department of General Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan;3. Department of Health Services Research, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Japan;1. Department of Internal Medicine, Boston Medical Center, Boston, MA, USA;2. Section of Gastroenterology, Boston Medical Center, Boston, MA, USA;3. Boston University School of Public Health, Boston, MA, USA;1. VA Tennessee Valley Healthcare System—Nashville, Department of Emergency Medicine, Nashville, TN, USA;2. Vanderbilt University, Department of Emergency Medicine, Nashville, TN, USA;3. Louis Stokes Cleveland VA Medical Center, Medicine Service, Cleveland, OH, USA;4. Case Western Reserve University School of Medicine, Department of Medicine, Cleveland, OH, USA;5. Orlando VA Medical Center, Department of Emergency Medicine, Orlando, FL, USA;6. University of Central Florida College of Medicine, Department of Medicine, Orlando, FL, USA;7. VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, PA, USA;8. University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, PA, USA;9. South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA;10. UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA;11. White River Junction VA Medical Center, Medicine Service, White River, Junction, VT, USA;12. Dartmouth Geisel School of Medicine, Department of Medicine, Hanover, NH, USA;13. (m) UT Health San Antonio, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA;14. Durham VA Health Care System, Primary Care Service, Durham, NC, USA;15. Duke University School of Medicine, Department of Medicine, Durham, NC, USA;p. VHA Specialty Care Service, VACO, Washington, DC, USA;1. UMass Memorial Medical Center, Department of Pharmacy, Worcester, MA, United States of America;2. UMass Memorial Medical School, Department of Emergency Medicine, Worcester, MA, United States of America;3. UMass Memorial Medical Center, Department of Emergency Medicine, Worcester, MA, United States of America;1. Department of Nursing, The Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel;2. Rambam Health Care Campus, Haifa, Israel;3. Clalit health service, 3498838;4. The Azrieli faculty of Medicine, Bar-Ilan University, Safed, Israel |
| |
| Abstract: | PurposeThe beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients.MethodsThis retrospective cohort study was conducted by using nationwide trauma registry data between 2004 and 2013 in Japan. Severe trauma patients (injury severity score (ISS) ≥ 16) who were transported directly to the hospital from the injury site were included in our analysis. Patients who were predicted to be untreatable (abbreviated injury score (AIS) = 6 and/or cardiopulmonary arrest at least one time before hospital arrival) were excluded. Participants were divided into either a physician or paramedics group based on the prehospital practitioner. The primary outcome was survival rate at discharge. Multivariable logistic regression analysis was performed to compare the outcome with adjustment for age, gender, ISS, cause of injury, and pre-hospital vital signs.ResultsA total of 30,283 patients were eligible for the selection criteria (physician: 1222, paramedics: 29,061). Overall, 172 patients (14.1%) died in the physician group compared to 3508 patients (12.1%) in the paramedics group. Patients in the physician group had higher ISSs than those in the paramedics group. In multivariable logistic regression, the physician group had an odds ratio (OR) of 1.16 (95% confidence interval (CI) = 0.97 to 1.40, p = 0.11) for in-hospital survival.ConclusionsOur results failed to show a difference in survival at discharge between non-physician-staffed ambulances and physician-staffed ambulances. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
