Background After decades of neglect, trauma service development in England has begun, but has focused on the in-hospital phase of the trauma care pathway, with a lack of national consensus on what constitutes the best pre-hospital care.
Objectives (1) To perform an empirical analysis of a five year regional dataset to ascertain the relationship between physician led pre-hospital care and major trauma mortality, and interpret these results in the context of existing literature on the topic.
(2) To analyse the epidemiology of trauma and trauma related deaths in the UK context, and comparing and contrasting these findings with historical cohorts.
Methods Impact of physician led care was analysed through multivariate logistic regression of a 5-year regional dataset, the Cambridgeshire Trauma Audit Research Project database. This multi-agency database is unique in that it is the first trauma database to have validated 100% case ascertainment, including pre-hospital data and pre-hospital deaths.
Results There were 775 patients who sustained major trauma within this cohort. The overall mortality rate was 58%. Physicians responded to 48% and non-physician led care was delivered for 52% of cases.
Young adults, especially males, continue to be at highest risk for trauma, and road traffic accidents continue to be the most prevalent mechanism of injury.
Upon multivariate logistic regression physician led pre-hospital care was associated with a significant reduction in major trauma mortality [OR]=0.47 (95% Confidence Interval 0.23 to 0.96; p=0.038). Subgroup analysis of ‘survivors to hospital’ revealed a greater effect size [OR]=0.30 (95% Confidence Interval 0.13 to 0.68; p=0.004).
A different distribution of frequency of death per day (figure 1) along with the shift in magnitude and certainty of effect size from entire cohort to ‘survivors to hospital’ cohort analysis, is predicted by our theoretical understanding of trauma related deaths. The ‘secondary peak’ in the bimodal distribution of trauma deaths could be limited through improved pre-hospital care.
Conclusion This empirical analysis of the first complete case ascertainment trauma dataset to include pre-hospital and in-hospital phases of trauma care, supports the hypothesis that physician led pre-hospital care reduces mortality from major trauma.⇓
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