@article{ref1,
title="Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: a retrospective analysis of the Japanese nationwide trauma  registry",
journal="Scandinavian journal of trauma, resuscitation and emergency medicine",
year="2021",
author="Otomo, Yasuhiro and Shiraishi, Atsushi and Uchiyama, Saya and Kojima, Mitsuaki and Endo, Akira",
volume="29",
number="1",
pages="e9-e9",
abstract="BACKGROUND: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the  limited number of high-quality studies. Furthermore, the advantage of physician-led  prehospital management might have been overestimated due to the shortened  prehospital time by helicopter transportation in some studies. The present study  aimed to evaluate the effect of physician-led prehospital management independent of  prehospital time. Also, subgroup analysis was performed to explore the subpopulation  that especially benefit from physician-led prehospital management. <br><br>METHODS: This  retrospective cohort study analyzed the data of Japan's nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were  transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of  primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4  propensity score-matched analysis. The propensity score was calculated using  potential confounders including patient demographics, mechanism of injury, vital  signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management  were explored by assessing interaction effects between physician-led prehospital  management and patient characteristics. <br><br>RESULTS: A total of 30,551 patients  (physician-led: 2976, paramedic-led: 27,575) were eligible for analysis, of whom  2690 propensity score-matched pairs (physician-led: 2690, paramedic-led: 10,760)  were generated and compared. Physician-led group showed significantly decreased  in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%]  and 1718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78-1.00], p =  0.044). Patients with age < 65 years, ISS ≥25, Abbreviated Injury Scale in pelvis  and lower extremities ≥3, and total prehospital time < 60 min were likely to benefit  from physician-led prehospital management. <br><br>CONCLUSIONS: Physician-led prehospital  trauma management was significantly associated with reduced in-hospital mortality  independent of prehospital time. The findings of exploratory subgroup analysis would  be useful for the future research to establish efficient dispatch system of  physician team.<p /> <p>Language: en</p>",
language="en",
issn="1757-7241",
doi="10.1186/s13049-020-00828-4",
url="http://dx.doi.org/10.1186/s13049-020-00828-4"
}