Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study
1 Université de Bourgogne, Service d'Anesthésie et Réanimation - SAMU 21, Hôpital Général, 3 Rue Faubourg Raines, Centre Hospitalier Universitaire de Dijon, Faculté de médecine, 21033 Dijon Cedex, France
2 Fédération des Urgences - SAMU59, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambert, 59037 Lille Cedex, France
3 INSERM CIE 01, Centre d'Investigation clinique - Epidémiologique clinique du CHU de Dijon, 21033 Dijon Cedex, France
4 Pôle Anesthésie Réanimation, CHU de Grenoble, 38043 La Tronche Cedex, France
5 Université Paris Sud-Paris XI, Hôpital Bicêtre, Département d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
6 Université de la Méditerranée, Centre de traumatologie et Département d'Anesthésie Réanimation, Centre Hospitalier Universitaire Nord, Boulevard Pierre Dramard, 13015 Marseille, France
7 Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire La Milétrie, rue de la Milétrie, 86000 Poitiers, France
8 Université Pierre et Marie Curie-Paris 6, Service d'Accueil des Urgences, GH Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France
Critical Care 2011, 15:R34 doi:10.1186/cc9982Published: 20 January 2011
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.
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.
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.
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.