Influence of prehospital physician presence on survival after severe trauma: Systematic review and meta-analysis.

Knapp, Jürgen; Häske, David; Böttiger, Bernd W; Limacher, Andreas; Stalder, Odile; Schmid, Annina; Schulz, Stephanie; Bernhard, Michael (2019). Influence of prehospital physician presence on survival after severe trauma: Systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery, 87(4), pp. 978-989. Wolters Kluwer, Lippincott Williams & Wilkins 10.1097/TA.0000000000002444

	Text Knapp JTraumaAcuteCareSurg 2019.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (748kB)
Preview	Text Knapp JTraumaAcuteCareSurg 2019_postprint.pdf - Accepted Version Available under License Publisher holds Copyright. Download (2MB) | Preview

BACKGROUND

As trauma is one of the leading causes of death worldwide, there is great potential for reducing mortality in trauma patients. However, there is continuing controversy over the benefit of deploying EMS physicians in the prehospital setting. The objective of this systematic review and meta-analysis is to assess how out-of-hospital hospital management of severely injured patients by EMS teams with and without physicians affects mortality.

METHODS

PubMed and Google Scholar were searched for relevant articles and the search was supplemented by a hand search. Injury severity in the group of patients treated by an EMS team including a physician had to be comparable to the group treated without a physician. Primary outcome parameter was mortality. Helicopter transport as a confounder was accounted for by sub-group analyses including only the studies with comparable modes of transport. Quality of all included studies was assessed according to the Cochrane handbook.

RESULTS

2,249 publications were found, 71 full-text articles assessed and 22 studies included. Nine of these studies were matched or adjusted for injury severity. The odds ratio (OR) of mortality was significantly lower in the EMS physician-treated group of patients: 0.81; 95% confidence interval (CI): 0.71-0.92. When analysis was limited to the studies that were adjusted or matched for injury severity, the OR was 0.86 (95% CI: 0.73-1.01). Analysing only studies published after 2005 yielded an OR for mortality of 0.75 (95% CI: 0.64-0.88) in the overall analysis and 0.81 (95% CI: 0.67-0.97) in the analysis of adjusted or matched studies. The OR was 0.80 (95% CI: 0.65-1.00) in the sub-group of studies with comparable modes of transport and 0.74 (95% CI: 0.53-1.03) in the more recent studies.

CONCLUSION

Prehospital management of severely injured patients by EMS teams including a physician seems to be associated with lower mortality. After excluding the confounder of helicopter transport we have shown a non-significant trend toward lower mortality.level IIISystematic review and meta-analysis.

Interest & Impact

Downloads

398 since deposited on 31 Jul 2019
92 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item