@article{ref1,
title="Estimating the effect of emergency care on early survival after traffic crashes",
journal="Accident analysis and prevention",
year="2013",
author="Clark, David E. and Winchell, Robert J. and Betensky, Rebecca A.",
volume="60",
number="",
pages="141-147",
abstract="INTRODUCTION: Traffic crash mortality is higher in rural areas, but it is unclear whether this is due to greater injury severity, time delays, or Emergency Medical Services (EMS) deficiencies. METHODS: Data from 2002-2003 were combined from the Fatality Analysis Reporting System (FARS) and an &quot;expanded version&quot; of the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). Weighted Cox and Weibull models for survival time (tSURV) were estimated, with time-varying covariates (TVC) having constant effects for specified time intervals following EMS arrival time (tEMS) and hospital arrival time (tHOS). The Weibull model was repeated with tSURV interval-censored to reflect uncertainty about the exact time of death, using an imputation method to accommodate interval censoring along with TVC. RESULTS: FARS contained records for 92,718 persons with fatal or incapacitating injuries, and NASS/CDS contained 5517 (weighted population of 642,716) with incapacitating injuries. All models associated mortality with increasing age, male sex, belt nonuse, higher speeds, and vehicle rollover. The interval-censored model associated EMS intervention with a beneficial effect until tEMS+30min, but not thereafter; hospital intervention was associated with a strongly beneficial effect that increased with time. Rural location was associated with a higher baseline hazard; a 50% reduction in rural prehospital time would theoretically reduce 4-h mortality by about 7%. CONCLUSION: Rural/urban disparity in crash mortality is mostly independent of time delays and EMS effects. However, survival models with TVC support clinical intuition of a &quot;golden hour&quot; in EMS care, and the importance of timely transport to a hospital.<p /> <p>Language: en</p>",
language="en",
issn="0001-4575",
doi="10.1016/j.aap.2013.08.019",
url="http://dx.doi.org/10.1016/j.aap.2013.08.019"
}