TY  - JOUR
PY  - 2011//
TI  - Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study
JO  - Critical care : the Official Journal of the Critical Care Forum
A1  - Yeguiayan, Jean-Michel
A1  - Garrigue, Delphine
A1  - Binquet, Christine
A1  - Jacquot, Claude
A1  - Duranteau, Jacques
A1  - Martin, Claude
A1  - Rayeh, Fatima
A1  - Riou, Bruno
A1  - Bonithon-Kopp, Claire
A1  - Freysz, Marc
A1  - Study Group, French Intensive Care Recorded In Severe Trauma First
SP  - R34
EP  - R34
VL  - 15
IS  - 1
N2  - INTRODUCTION: 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 Reanimation) with non-medical pre-hospital management provided by Fire Brigades (non-SMUR) on 30-day mortality. METHODS: 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. RESULTS: Among 2703 patients, 2513 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 (OR: 0.55, 95% CI: 0.32-0.94, p = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. CONCLUSIONS: 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 need to be assessed in further studies.<p />  <p>Language: en</p>
LA  - en
SN  - 1364-8535
UR  - http://dx.doi.org/10.1186/cc9982
ID  - ref1
ER  -