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International Journal of Emergency Medicine
Published in: International Journal of Emergency Medicine 1/2020

Open Access 01-12-2020 | Central Nervous System Trauma | Review

A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

Authors: Alexander F. Bedard, Lina V. Mata, Chelsea Dymond, Fabio Moreira, Julia Dixon, Steven G. Schauer, Adit A. Ginde, Vikhyat Bebarta, Ernest E. Moore, Nee-Kofi Mould-Millman

Published in: International Journal of Emergency Medicine | Issue 1/2020

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Abstract

Background

Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation.

Main body

We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure.

Conclusion

The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.
Appendix
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Metadata
Title
A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes
Authors
Alexander F. Bedard
Lina V. Mata
Chelsea Dymond
Fabio Moreira
Julia Dixon
Steven G. Schauer
Adit A. Ginde
Vikhyat Bebarta
Ernest E. Moore
Nee-Kofi Mould-Millman
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2020
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-020-00324-7

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