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


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
doi: 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:

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


Zdroje

1. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390: 1260–1344. doi: 10.1016/S0140-6736(17)32130-X 28919118

2. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354: 366–378. doi: 10.1056/NEJMsa052049 16436768

3. Eastman AB, Mackenzie EJ, Nathens AB. Sustaining a coordinated, regional approach to trauma and emergency care is critical to patient health care needs. Health Aff (Millwood). 2013;32: 2091–2098. doi: 10.1377/hlthaff.2013.0716 24301391

4. Jenkins P, Rogers J, Kehoe A, Smith JE. An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre. Emerg Med J. 2015;32: 364–367. doi: 10.1136/emermed-2013-203402 24668398

5. Cole E, Lecky F, West A, Smith N, Brohi K, Davenport R. The Impact of a Pan-regional Inclusive Trauma System on Quality of Care: Annals of Surgery. 2016;264: 188–194. doi: 10.1097/SLA.0000000000001393 26465783

6. Frink M, Kühne C, Debus F, Pries A, Ruchholtz S. [The TraumaNetzwerk DGU project. Goals, conception, and successes achieved]. Unfallchirurg. 2013;116: 61-71-73. doi: 10.1007/s00113-012-2326-5 23307433

7. Dehli T, Gaarder T, Christensen BJ, Vinjevoll OP, Wisborg T. Implementation of a trauma system in Norway: a national survey. Acta Anaesthesiol Scand. 2015;59: 384–391. doi: 10.1111/aas.12467 25582880

8. Garwe T, Cowan LD, Neas BR, Sacra JC, Albrecht RM. Directness of transport of major trauma patients to a level I trauma center: a propensity-adjusted survival analysis of the impact on short-term mortality. J Trauma. 2011;70: 1118–1127. doi: 10.1097/TA.0b013e3181e243b8 20693925

9. Sampalis JS, Denis R, Fréchette P, Brown R, Fleiszer D, Mulder D. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma. 1997;43: 288-295-296.

10. Härtl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma. 2006;60: 1250–1256; discussion 1256. doi: 10.1097/01.ta.0000203717.57821.8d 16766968

11. Nathens AB, Maier RV, Brundage SI, Jurkovich GJ, Grossman DC. The effect of interfacility transfer on outcome in an urban trauma system. J Trauma. 2003;55: 444–449. doi: 10.1097/01.TA.0000047809.64699.59 14501884

12. Rogers FB, Osler TM, Shackford SR, Cohen M, Camp L, Lesage M. Study of the outcome of patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting. J Trauma. 1999;46: 328–333. doi: 10.1097/00005373-199902000-00022 10029042

13. Hill AD, Fowler RA, Nathens AB. Impact of interhospital transfer on outcomes for trauma patients: a systematic review. J Trauma. 2011;71: 1885–1900; discussion 1901. doi: 10.1097/TA.0b013e31823ac642 22182900

14. Williams T, Finn J, Fatovich D, Jacobs I. Outcomes of different health care contexts for direct transport to a trauma center versus initial secondary center care: a systematic review and meta-analysis. Prehosp Emerg Care. 2013;17: 442–457. doi: 10.3109/10903127.2013.804137 23845080

15. Yeguiayan J-M, Garrigue D, Binquet C, Jacquot C, Duranteau J, Martin C, et al. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study. Crit Care. 2011;15: R34. doi: 10.1186/cc9982 21251331

16. the Traumabase Group, Hamada SR, Rosa A, Gauss T, Desclefs J-P, Raux M, et al. Development and validation of a pre-hospital “Red Flag” alert for activation of intra-hospital haemorrhage control response in blunt trauma. Critical Care. 2018;22. doi: 10.1186/s13054-018-2026-9 29728151

17. Hamada SR, Gauss T, Duchateau F-X, Truchot J, Harrois A, Raux M, et al. Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients. J Trauma Acute Care Surg. 2014;76: 1476–1483. doi: 10.1097/TA.0000000000000239 24854319

18. Riou B, Carli P. Le traumatisé grave. Actualités en réanimation préhospitalière. Journées scientifiques du SAMU de France. 2002;Vittel 9–11 octobre 2002. Intensive Care Med. 2006;32: 405–412. doi: 10.1007/s00134-005-0063-8 16485093

19. Sartorius D, Le Manach Y, David J-S, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38: 831–837. doi: 10.1097/CCM.0b013e3181cc4a67 20068467

20. Raux M, Thicoïpé M, Wiel E, Rancurel E, Savary D, David J-S, et al. Comparison of respiratory rate and peripheral oxygen saturation to assess severity in trauma patients.

21. The Traumabase Group, Figueiredo S, Taconet C, Harrois A, Hamada S, Gauss T, et al. How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study. Annals of Intensive Care. 2018;8. doi: 10.1186/s13613-018-0420-8 29980953

22. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27: 370–378. 3106646

23. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29: 623–629. doi: 10.1097/00005373-198905000-00017 2657085

24. American College of Surgeons, Committee on Trauma. Resources for optimal care of the injured patient. Chicago, Ill.: American College of Surgeons, Committee on Trauma; 2014.

25. Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS medicine. 2007;4: e297. doi: 10.1371/journal.pmed.0040297 17941715

26. Hale C. Basic statistical reporting for articles published in biomedical journals: Classic methods paper. International Journal of Nursing Studies. 2015;52: 4. doi: 10.1016/j.ijnurstu.2014.09.007 25441759

27. Moons KGM, Altman DG, Reitsma JB, Ioannidis JPA, Macaskill P, Steyerberg EW, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): Explanation and Elaboration. Annals of Internal Medicine. 2015;162: W1. doi: 10.7326/M14-0698 25560730

28. Buuren S, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. Journal of statistical software. 2011;45. Available: http://doc.utwente.nl/78938/ doi: 10.18637/jss.v045.i01

29. Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied logistic regression. John Wiley & Sons; 2013. Available: http://books.google.com/books?hl=en&lr=&id=64JYAwAAQBAJ&oi=fnd&pg=PA313&dq=info:QYB4u56LccYJ:scholar.google.com&ots=DrkS603smK&sig=hKtWAl9-_-bIkvzkyftnCdfc-cI

30. Steyerberg EW, Harrell FE, Borsboom GJ, Eijkemans MJC, Vergouwe Y, Habbema JDF. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. Journal of clinical epidemiology. 2001;54: 774–781. doi: 10.1016/s0895-4356(01)00341-9 11470385

31. Hsieh FY, Bloch DA, Larsen MD. A simple method of sample size calculation for linear and logistic regression. Stat Med. 1998;17: 1623–1634. doi: 10.1002/(sici)1097-0258(19980730)17:14<1623::aid-sim871>3.0.co;2-s 9699234

32. Billeter AT, Miller FB, Harbrecht BG, Bowen W, Stephens MJ, Postel GC, et al. Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome. Am J Surg. 2014;207: 459–466. doi: 10.1016/j.amjsurg.2013.04.015 24674826

33. Garwe T, Cowan LD, Neas B, Cathey T, Danford BC, Greenawalt P. Survival Benefit of Transfer to Tertiary Trauma Centers for Major Trauma Patients Initially Presenting to Nontertiary Trauma Centers: OUTCOMES IN TRAUMA PATIENT TRANSFERS. Academic Emergency Medicine. 2010;17: 1223–1232. doi: 10.1111/j.1553-2712.2010.00918.x 21175521

34. Joosse P, Saltzherr T-P, van Lieshout WAM, van Exter P, Ponsen K-J, Vandertop WP, et al. Impact of secondary transfer on patients with severe traumatic brain injury. J Trauma Acute Care Surg. 2012;72: 487–490. doi: 10.1097/TA.0b013e318226ed59 22327988

35. Newgard CD, McConnell KJ, Hedges JR, Mullins RJ. The Benefit of Higher Level of Care Transfer of Injured Patients From Nontertiary Hospital Emergency Departments: The Journal of Trauma: Injury, Infection, and Critical Care. 2007;63: 965–971. doi: 10.1097/TA.0b013e31803c5665 17993937

36. Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61: 1–20.

37. Sugerman DE, Xu L, Pearson WS, Faul M. Patients with severe traumatic brain injury transferred to a Level I or II trauma center: United States, 2007 to 2009. J Trauma Acute Care Surg. 2012;73: 1491–1499. doi: 10.1097/TA.0b013e3182782675 23188242

38. Rozenberg A, Danish T, Dombrovskiy VY, Vogel TR. Outcomes after Motor Vehicle Trauma: Transfers to Level I Trauma Centers Compared with Direct Admissions. The Journal of Emergency Medicine. 2017;53: 295–301. doi: 10.1016/j.jemermed.2017.04.001 28528722

39. Benjamin ER, Khor D, Cho J, Biswas S, Inaba K, Demetriades D. The Age of Undertriage: Current Trauma Triage Criteria Underestimate The Role of Age and Comorbidities in Early Mortality. The Journal of Emergency Medicine. 2018;55: 278–287. doi: 10.1016/j.jemermed.2018.02.001 29685471

40. Ray WA. Improving automated database studies. Epidemiology. 2011;22: 302–304. doi: 10.1097/EDE.0b013e31820f31e1 21464650

41. Newgard C, Malveau S, Staudenmayer K, Wang NE, Hsia RY, Mann NC, et al. Evaluating the Use of Existing Data Sources, Probabilistic Linkage, and Multiple Imputation to Build Population-based Injury Databases Across Phases of Trauma Care: BUILDING POPULATION-BASED INJURY DATABASES ACROSS PHASES OF CARE. Academic Emergency Medicine. 2012;19: 469–480. doi: 10.1111/j.1553-2712.2012.01324.x 22506952

42. Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, Holcomb JB. Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care. Injury. 2017;48: 5–12. doi: 10.1016/j.injury.2016.10.037 27847192

43. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma: The PROPPR Randomized Clinical Trial. JAMA. 2015;313: 471. doi: 10.1001/jama.2015.12 25647203

44. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, et al. Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. New England Journal of Medicine. 2018;379: 315–326. doi: 10.1056/NEJMoa1802345 30044935

45. Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. The Lancet. 2018;392: 283–291.

46. Cornwall K, Oliver M, Bein K, Roncal S, Chu M, Dinh M. Outcomes at non-trauma centres within a trauma referral network: A five-year retrospective cohort study from Australia. Australasian Emergency Care. 2019;22: 42–46. doi: 10.1016/j.auec.2019.01.002 30998871

47. Dean JM, Vernon DD, Cook L, Nechodom P, Reading J, Suruda A. Probabilistic linkage of computerized ambulance and inpatient hospital discharge records: a potential tool for evaluation of emergency medical services. Ann Emerg Med. 2001;37: 616–626. doi: 10.1067/mem.2001.115214 11385330

48. Newgard CD, Zive D, Malveau S, Leopold R, Worrall W, Sahni R. Developing a statewide emergency medical services database linked to hospital outcomes: a feasibility study. Prehosp Emerg Care. 2011;15: 303–319. doi: 10.3109/10903127.2011.561404 21612384

49. Newgard CD. Validation of probabilistic linkage to match de-identified ambulance records to a state trauma registry. Acad Emerg Med. 2006;13: 69–75. doi: 10.1197/j.aem.2005.07.029 16365326


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2019 Číslo 11