Skip to Main content Skip to Navigation
Journal articles

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study.

Abstract : INTRODUCTION: Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. METHODS: The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. RESULTS: Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. CONCLUSIONS: This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.
Keywords : Blunt trauma
Complete list of metadatas

Cited literature [34 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-00709107
Contributor : Ed. Bmc <>
Submitted on : Sunday, June 17, 2012 - 6:24:04 PM
Last modification on : Thursday, August 27, 2020 - 11:36:03 AM
Long-term archiving on: : Tuesday, September 18, 2012 - 2:25:35 AM

Files

cc9982.pdf
Publisher files allowed on an open archive

Identifiers

Citation

Jean-Michel Yeguiayan, Delphine Garrigue, Christine Binquet, Claude Jacquot, Jacques Duranteau, et al.. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study.. Critical Care, BioMed Central, 2011, 15 (1), pp.R34. ⟨10.1186/cc9982⟩. ⟨inserm-00709107⟩

Share

Metrics

Record views

819

Files downloads

1308