Abstract
Purpose
The 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.
Methods
This 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.
Results
A 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.
Conclusions
Our results failed to show a difference in survival at discharge between non-physician-staffed
ambulances and physician-staffed ambulances.
Keywords
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Article Info
Publication History
Published online: November 09, 2018
Accepted:
November 8,
2018
Received in revised form:
November 6,
2018
Received:
August 29,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
