Direct transport vs secondary transfer to level I trauma centers in a French exclusive trauma system: Impact on mortality and determinants of triage on road-traffic victims

English version

Autoři: Sophie Rym Hamada ^aff001; Nathalie Delhaye ^aff003; Samuel Degoul ^aff004; Tobias Gauss ^aff005; Mathieu Raux ^aff006; Marie-Laure Devaud ^aff007; Johan Amani ^aff008; Fabrice Cook ^aff009; Camille Hego ^aff010; Jacques Duranteau ^aff011; Alexandra Rouquette ^aff012;
Působiště autorů: Université paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France ^aff001; CESP, INSERM, Université paris Sud, UVSQ, Université Paris-Saclay, Paris; CESP, INSERM, Maison de Solenn, Paris, France ^aff002; Sorbonne Université and Department of Anesthesiology and Critical Care, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France ^aff003; Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace, Department of Anesthesiology and Surgical Intensive Care, Mulhouse, France ^aff004; Hôpitaux Universitaires Paris Nord Val de Seine, Department of Anesthesiology and Critical Care, AP-HP, Hôpital Beaujon, Clichy, France ^aff005; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d’Anesthésie Réanimation, Paris, France ^aff006; SAMU 95, Centre Hospitalier René Dubos, Pontoise, France ^aff007; SAMU 78, Centre Hospitalier de Versailles, Le Chesnay, France ^aff008; Université Paris Est, Department of Anesthesiology and Critical Care, APHP, Hôpital Henri Mondor, Créteil, France ^aff009; Hôpitaux Universitaires Paris Nord Val de Seine, Department of Anesthesiology and Critical Care, AP-HP, Beaujon, Clichy, France ^aff010; Université Paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France ^aff011; Université paris Sud, Department of Anesthesiology and Critical Care, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France ^aff011; CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France (Postal address: CESP, INSERM, Maison de Solenn, Paris, France ^aff012; Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, APHP, Le Kremlin-Bicêtre, France ^aff013
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223809

Souhrn

Background

Transporting a severely injured patient directly to a trauma center (TC) is consensually considered optimal. Nevertheless, disagreement persists regarding the association between secondary transfer status and outcome. The aim of the study was to compare adjusted mortality between road traffic trauma patients directly or secondarily transported to a level 1 trauma center (TC) in an exclusive French trauma system with a physician staffed prehospital emergency medical system (EMS).

Methods

A retrospective cohort study was performed using 2015–2017 data from a regional trauma registry (Traumabase®), an administrative database on road-traffic accidents and prehospital-EMS records.

Multivariate logistic regression models were computed to determine the role of the modality of admission on mortality and to identify factors associated with secondary transfer. The primary outcome was day-30 mortality.

Results: During the study period, 121.955 victims of road-traffic accident were recorded among which 4412 trauma patients were admitted in the level 1 regional TCs, 4031 directly and 381 secondarily transferred from lower levels facilities. No significant association between all-cause 30-day mortality and the type of transport was observed (Odds ratio 0.80, 95% confidence interval (CI) [0.3–1.9]) when adjusted for potential confounders. Patients secondarily transferred were older, with low-energy mechanism and presented higher head and abdominal injury scores. Among all 947 death, 43 (4.5%) occurred in lower-level facilities. The population-based undertriage leading to death was 0.15%, 95%CI [0.12–0.19].

Conclusion

In an exclusive trauma system with physician staffed prehospital care, road-traffic victims secondarily transferred to a TC do not have an increased mortality when compared to directly transported patients.

Klíčová slova:

Physicians – Roads – Traumatic injury – Head injury – France – Antiplatelet therapy – Intensive care units

Zdroje

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