Citation

Yeguiayan JM, Garrigue D, Binquet C, Jacquot C, Duranteau J, Martin C, Rayeh F, Riou B, Bonithon-Kopp C, Freysz M, Study Group FI. Crit. Care 2011; 15(1): R34.

Copyright

(Copyright © 2011, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/cc9982

PMID

21251331

PMCID

PMC3222071

Abstract

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.

Language: en