The golden hour of shock – how time is running out: prehospital time intervals in Germany—a multivariate analysis of 15, 103 patients from the TraumaRegister DGU®
- Hendrik Wyen1,2,
- Rolf Lefering2,
- Marc Maegele3,
- Thomas Brockamp2,3,
- Arasch Wafaisade3,
- Sebastian Wutzler1,
- Felix Walcher1,
- Ingo Marzi1,
- the TraumaRegister DGU
- 1Department of Trauma, Hand and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany
- 2Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
- 3Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Cologne, Germany
- Correspondence to Dr Hendrik Wyen, Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt D-60590, Germany;
- Received 11 September 2012
- Revised 11 September 2012
- Accepted 12 November 2012
- Published Online First 20 December 2012
Objectives Although prehospital treatment algorithms have changed over the past years, the prehospital time of multiple trauma patients of some 70 min and the on-scene-treatment time (OST) of some 30 min have not changed since 1993. The aim of this study was to critically assess specific interventions and conditions at the scene in relation to their impact on prehospital rescue intervals.
Methods We performed a retrospective data analysis of all multiple injured patients from the TraumaRegister DGU (English: German Trauma Society) from January 1993 to December 2010. Exclusion criteria were missing or implausible data regarding prehospital timelines. With OST as an independent variable, different models of multivariate regression were performed to identify parameters with relevant impact on the OST.
Results 15 103 datasets were included in this study. Based on the mean OST of 32.7 (±18.6) min and a constant absolute term of 16.2 (±1.5) min, we identified seven procedures and nine environmental parameters with significant impact on OST. Intubation (9.3±0.8 min) and being a car occupant (8.0±0.8 min) were associated with the most prolonged OSTs. A Glasgow Coma Scale ≤8 (−4.5±0.7 min) and cardiopulmonary resuscitation (−2.8±1.7 min) resulted in its most relevant reduction. Admission to a Level III facility led to a reduced overall prehospital time (60.0±24.6 min) compared with Level I (70.0±28.5 min) and II (66.8±27.4 min) trauma centres.
Conclusions This study identified characteristic interventions and conditions with significant impact on prehospital treatment times. Current treatment concepts should be re-evaluated with respect to these results.