A few months ago, I heard this statement at a conference I was attending:
“Of course, prenotification of the trauma team by EMS decreases hospital mortality”
And of course, whenever I hear someone say “of course”, it makes me think about it. How do we know for sure? So I made one of my frequent trips to PubMed to find the basis for the statement.
And guess what? He shouldn’t have said “of course.” The literature is very scarce on this topic. There are actually some good papers detailing the advantages of prehospital notification for things like stroke and STEMI. But trauma?
A group in Melbourne, Australia performed a systematic review of the literature on this topic for the Australia-India Trauma System Collaboration. They were interesting in finding information about early (<24 hour) and overall (<30 day) mortality, as well as trauma team presence, time to critical hospital interventions, and hospital length of stay. Over a thousand articles were identified, but half did not have proper study design, and a quarter weren’t about notification. After excluding those, and others that failed other criteria, they were left with only three to review!
Here are the factoids:
- Two of the studies were small, with only 81 and 269 participants and individual hospitals
- The remaining study was a very large retrospective analysis of over 72,000 patients from 59 hospitals in Canada
- All three had serious risk for bias and significant confounding variables
- The large study showed a significant improvement in overall mortality from 32% to 23%, the smaller studies did not. But the study quality was so poor for this outcome that we can’t really be certain, and these numbers seem very high coming from Canada.
- No conclusions could be drawn for short term mortality, length of stay, or time to interventions in the ED
- The studies only involved high-income countries; nothing could be learned for low to medium-income countries.
Bottom line: Three studies in 27 years??! So sad. It certainly seems like having the trauma team informed and prepped in advance should count for something. But like so many other things in this business, we just don’t know for sure. Having everyone in place and ready to receive the patient, and getting other in-hospital resources ready (e.g. OR) may shorten time to definitive, life-saving treatment. But for now, we’ll just have to pretend. Until someone designs and performs a much better study.
- When your prehospital providers bring a patient in “non-standard position”
- Can prehospital providers estimate blood loss?
- Prehospital lactate: ready for prime time?
Reference: Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review. J Evidence Based Med 10(3):212-221, 2017.