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

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Knapp, Jürgen; Limacher, Andreas; Stalder, Odile and Schmid, Annina Bernadette

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2163-0755

Publisher:

Wolters Kluwer, Lippincott Williams & Wilkins

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

31 Jul 2019 10:34

Last Modified:

31 Oct 2019 12:19

Publisher DOI:

10.1097/TA.0000000000002444

PubMed ID:

31335754

BORIS DOI:

10.7892/boris.132215

URI:

https://boris.unibe.ch/id/eprint/132215

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