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Prehospital critical care is associated with increased survival in adult trauma patients in Scotland
  1. Alistair Maddock1,2,
  2. Alasdair R Corfield2,3,
  3. Michael J Donald2,4,
  4. Richard M Lyon5,6,
  5. Neil Sinclair2,7,
  6. David Fitzpatrick8,
  7. David Carr9,
  8. Stephen Hearns2,3
  1. 1 Anaesthetics, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2 Emergency Medical Retrieval Service, ScotSTAR, Paisley, UK
  3. 3 Emergency Medicine, Royal Alexandra Hospital, Paisley, UK
  4. 4 Emergency Medicine, Ninewells Hospital, Dundee, UK
  5. 5 Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  6. 6 Pre-hospital Emergency Medical Care, University of Surrey, Guildford, Surrey, UK
  7. 7 Scottish Ambulance Service, Edinburgh, UK
  8. 8 Faculty of Health Science and Sport, University of Stirling, Stirling, UK
  9. 9 Information Services Division, NHS National Services Scotland, Glasgow, UK
  1. Correspondence to Alistair Maddock, Anaesthetics, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; alistair.maddock{at}nhs.net

Abstract

Background Scotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally.

Methods National registry-based retrospective cohort study using 2011–2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables.

Results Our data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p<0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01).

Conclusion Prehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.

  • pre-hospital
  • trauma
  • prehospital care
  • prehospital care, doctors in PHC
  • prehospital care, critical care transport
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Footnotes

  • Twitter @OmAndScop, @al_corfield

  • Contributors ARC conceived the study. AM, ARC, SH, MJD, RML, NS and DF drafted the protocol. DC, ARC and AM provided statistical analysis and data interpretation. AM performed a literature review and wrote the first draft. All authors critically reviewed and provided input to the submitted manuscript. The majority of the suggested revisions to all versions of the manuscript were discussed and implemented by AM, ARC and DC with some input from the other authors.

  • Funding This study was supported with funding from the EMRS endowment fund (ref. 1441) to pay for independent statistical analysis of the data.

  • Competing interests MJD and RML are the clinical leads of two of the prehospital critical care teams which were the subject of this study; SH was previously the clinical lead of the third.

  • Patient and public involvement statement This research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval/clinical trial registration: not required, as data were fully anonymised at source before being released to the investigators.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data may be obtained for research and audit purposes from the Scottish Trauma Audit Group: https://www.stag.scot.nhs.uk/Contacts/Main.htm.

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