In my last post, we looked at an older study that kind of examined the scoop and run vs stay and play debate.  Let’s move forward in time a little bit, and evaluate the two options in a penetrating trauma model.

This one is from the anesthesia and intensive care departments at the university hospital in Copenhagen. The authors prospectively captured information on 462 penetrating trauma victims, then looked up their 30 day survival status in a national administrative database.

Here are the factoids:

• Only 95% of patient records (446) were available for 30 day review (better that in the US!)
• Of those, 40 were dead (9%)
• Using raw statistics, there seemed to be a significant increase in mortality if the prehospital crew was on scene more than 20 minutes
• However, when corrected for age, sex, injury pattern, etc. there was no significant difference in survival for short vs longer scene stays
• Multivariate analysis identified the number of procedures performed at the scene as a significant predictor of mortality, regardless of time

Bottom line: We still can’t seem to show a difference in patients who are tossed in the back of the squad and driven vs those who have IVs, immobilization, and other things done to begin resuscitation and increase safety prior to transport! However, the bit about number of procedures is intriguing. Is this just another surrogate for time? Are there unrecognized complications from them that affect survival?

Next time, I’ll look at a recent publication from the US that gives us yet another angle on this question.

Reference: On-scene time and outcome after penetrating trauma: an observational study. Emerg Med J 28(9):87-801, 2011.

I previously published a series on the concept of scoop and run vs stay and play. For those new to the concept, it involves decision-making by prehospital providers to throw the patient into the ambulance and book it to the trauma center, or perform potentially life-saving interventions on scene first.

I’m going to repost the series first to give you a historical perspective on this idea. Then I’ll finish up with the results of a recent multi-center trial conducted by EAST to provide the finishing touch.

For trauma patients time is the enemy and there are two different flavors of scoop and run vs stay and play. The more commonly understood one has to do with treating on scene (or not) before going to a high level (I or II) trauma center. The other flavor that rural prehospital providers face is, do I take the patient to a nearby hospital that is not a high level trauma center (III or IV) to stay and play, or do I scoop and run to the nearest Level I or II center which may be farther away?

Here are the factoids:

• Admissions to a group of 8 trauma centers were analyzed over a 3 year period, and included a total of 1112 patients
• A total of 76% were taken directly to a Level I trauma center (scoop and run, 76%); 24% were transferred to the trauma center from another hospital (stay and play?).
• Patients who were taken to a non-trauma center first received 3 times more IV crystalloid, 12 times more blood, and were nearly 4 times more likely to die!

Obviously, the cause of this increased mortality cannot be determined from the data. The authors speculated that patients may undergo more aggressive resuscitation with crystalloid and blood at the outside hospital making them look better than they really are, and then they die. Alternatively, they may have been under-resuscitated at the outside hospital, making it more difficult to ensure survival at the trauma center.

Bottom line: This is an interesting paper, but it’s kind of a mutant. When I think about the true stay and play concent, I’m really thinking about delays going to a high-level trauma center, not a lower level trauma hospital first! And the authors never really define a “nontrauma hospital.” Does a Level III or IV center count? How did patients who stayed at the outside hospital do?

Obviously, a lot of work needs to be done to add detail to this particular paper. In my next post, I’ll look at this concept as it applies to patients with penetrating injury.

Reference: Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer’s effect on mortality. J Trauma 69(3):595-601, 2010.