Journal
ANNALS OF EMERGENCY MEDICINE
Volume 66, Issue 1, Pages 30-41Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.annemergmed.2014.12.004
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Funding
- (University of Washington Data Coordinating Center) from the National Heart, Lung, and Blood Institute [5U01 HL077863]
- (Medical College of Wisconsin) from the National Heart, Lung, and Blood Institute [HL077866]
- (University of Washington) from the National Heart, Lung, and Blood Institute [HL077867]
- (University of Pittsburgh) from the National Heart, Lung, and Blood Institute [HL077871]
- (St. Michael's Hospital) from the National Heart, Lung, and Blood Institute [HL077872]
- (Oregon Health & Science University) from the National Heart, Lung, and Blood Institute [HL077873]
- (University of Alabama at Birmingham) from the National Heart, Lung, and Blood Institute [HL077881]
- (Ottawa Health Research Institute) from the National Heart, Lung, and Blood Institute [HL077885]
- (University of Texas Southwest Medical Center/Dallas) from the National Heart, Lung, and Blood Institute [HL077887]
- (University of California San Diego) from the National Heart, Lung, and Blood Institute [HL077908]
- US Army Medical Research and Material Command
- Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health
- Defence Research and Development Canada
- Heart and Stroke Foundation of Canada
- American Heart Association
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Study objective: We evaluate patients with shock and traumatic brain injury who were previously enrolled in an out-ofhospital clinical trial to test the association between out-of-hospital time and outcome. Methods: This was a secondary analysis of patients with shock and traumatic brain injury who were aged 15 years or older and enrolled in a Resuscitation Outcomes Consortium out-of-hospital clinical trial by 81 emergency medical services agencies transporting to 46 Level I and II trauma centers in 11 sites (May 2006 through May 2009). Inclusion criteria were systolic blood pressure less than or equal to 70 mm Hg or systolic blood pressure 71 to 90 mm Hg with pulse rate greater than or equal to 108 beats/min (shock cohort) and Glasgow Coma Scale score less than or equal to 8 (traumatic brain injury cohort); patients meeting both criteria were placed in the shock cohort. Primary outcomes were 28-day mortality (shock cohort) and 6-month Glasgow Outcome Scale-Extended score less than or equal to 4 (traumatic brain injury cohort). Results: There were 778 patients in the shock cohort (26% 28-day mortality) and 1,239 patients in the traumatic brain injury cohort (53% 6-month Glasgow Outcome Scale-Extended score <4). Out-of-hospital time greater than 60 minutes was not associated with worse outcomes after accounting for important confounders in the shock cohort (adjusted odds ratio [a0R] 1.42; 95% confidence interval [Cl] 0.77 to 2.62) or traumatic brain injury cohort (aOR 0.77; 95% Cl 0.51 to 1.15). However, shock patients requiring early critical hospital resources and arriving after 60 minutes had higher 28day mortality (aOR 2.37; 95% Cl 1.05 to 5.37); this finding was not observed among a similar traumatic brain injury subgroup. Conclusion: Among out-of-hospital trauma patients meeting physiologic criteria for shock and traumatic brain injury, there was no association between time and outcome. However, the subgroup of shock patients requiring early critical resources and arriving after 60 minutes had higher mortality.
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