Does Prehospital Advanced Life Support for Major Trauma Patients Improve Survival to Hospital in New Zealand?
Authors List
Campbell, N., Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Davie, G., Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Lilley, R., Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Morgaine, K., Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Dicker, B., Hato Hone St John, Mt Wellington, Auckland, New Zealand
Kool, B., Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
Introduction
Both prehospital advanced life support (ALS) and basic life support (BLS) are performed on trauma patients in New Zealand. Multiple published systematic reviews have not found a conclusive survival benefit for trauma patients who received prehospital advanced life support compared to basic life support.
Aims
The aim of this study was to understand the relationship between prehospital ALS versus BLS only and survival to hospital for major trauma patients in New Zealand.
Methods
This study examined major trauma patients attended by a road ambulance between 1 December 2016 to 30 November 2018. Paediatric patients were excluded and only cases in which the highest qualified ambulance officer on-scene was an intensive care paramedic were included. Survival to first hospital was the outcome. A multivariable model incorporating propensity scores to adjust for baseline differences was used to estimate the odds of survival for patients who received ALS compared to BLS only.
Results
A total of 1,118 attended patients met the inclusion criteria; 61% (n=680) had a survivable injury (an injury severity score of less than 25) and 40% (n=448) were injured in a rural location. Of all patients, 59% (n=661) received ALS and 41% (n=457) received BLS only. Mortality was low with only 5% (n=52) not surviving to hospital. After adjustment, the odds of survival for patients who received ALS were 1.49 times higher than patients who received BLS only (95% CI 0.66, 3.35).
Conclusions
Although the adjusted odds ratio suggests that ALS provides a survival benefit for major trauma patients, our results indicate there is considerable uncertainty with this estimate. At a population level, ALS may provide a survival benefit but the possibility that ALS may be harmful cannot be ruled out. Individual benefit of prehospital ALS for major trauma patients cannot be determined from this study.
Campbell, N., Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Davie, G., Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Lilley, R., Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Morgaine, K., Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Dicker, B., Hato Hone St John, Mt Wellington, Auckland, New Zealand
Kool, B., Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
Introduction
Both prehospital advanced life support (ALS) and basic life support (BLS) are performed on trauma patients in New Zealand. Multiple published systematic reviews have not found a conclusive survival benefit for trauma patients who received prehospital advanced life support compared to basic life support.
Aims
The aim of this study was to understand the relationship between prehospital ALS versus BLS only and survival to hospital for major trauma patients in New Zealand.
Methods
This study examined major trauma patients attended by a road ambulance between 1 December 2016 to 30 November 2018. Paediatric patients were excluded and only cases in which the highest qualified ambulance officer on-scene was an intensive care paramedic were included. Survival to first hospital was the outcome. A multivariable model incorporating propensity scores to adjust for baseline differences was used to estimate the odds of survival for patients who received ALS compared to BLS only.
Results
A total of 1,118 attended patients met the inclusion criteria; 61% (n=680) had a survivable injury (an injury severity score of less than 25) and 40% (n=448) were injured in a rural location. Of all patients, 59% (n=661) received ALS and 41% (n=457) received BLS only. Mortality was low with only 5% (n=52) not surviving to hospital. After adjustment, the odds of survival for patients who received ALS were 1.49 times higher than patients who received BLS only (95% CI 0.66, 3.35).
Conclusions
Although the adjusted odds ratio suggests that ALS provides a survival benefit for major trauma patients, our results indicate there is considerable uncertainty with this estimate. At a population level, ALS may provide a survival benefit but the possibility that ALS may be harmful cannot be ruled out. Individual benefit of prehospital ALS for major trauma patients cannot be determined from this study.