Citation

Wilson S, Gangathimmaiah V. J. Trauma Acute Care Surg. 2017; 83(5): 965-974.

Affiliation

Emergency Department, The Townsville Hospital, Queensland, Australia, No conflicts of interest Lifeflight Retrieval Medicine, Townsville Base, PO Box 8300, Garbutt, Qld 4814, Australia, No conflicts of interest.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001559

PMID

28590350

Abstract

BACKGROUND: There is substantial variation worldwide in prehospital management of trauma and the role of doctors is controversial. The objective of this review was to determine whether prehospital management by doctors affects outcomes in major trauma, including the pre-specified subgroup of severe traumatic brain injuries (TBI) when compared to management by other advanced life support providers.

METHODS: EMBASE, MEDLINE(R), PubMed, SciELO, Trip, Web of Science and Zetoc were searched for published articles. HSRProj, OpenGrey and the WHO International Clinical Trials Registry Platform were searched for unpublished data. Relevant reference lists were hand-searched. There were no limits on publication year, but articles were limited to the English language. Authors were contacted for further information as required. Quality was assessed using the Downs and Black criteria. Mortality was the primary outcome and disability was the secondary outcome of interest. Studies were subjected to a descriptive analysis alone without a meta-analysis was due to significant study heterogeneity. All searches, quality assessment, data abstraction and data analysis was performed by two reviewers independently.

RESULTS: 2037 articles were identified, 49 full-text articles assessed and eight studies included. The included studies consisted of one randomised controlled trial with 375 participants and seven observational studies with over 4451 participants. All included studies were at a moderate to high risk of bias. Six of the eight included studies showed an improved outcome with prehospital management by doctors, five in terms of mortality and one in terms of disability. Two studies found no significant difference.

CONCLUSION: There appears to be an association between prehospital management by doctors and improved survival in major trauma. There may also be an association with improved survival and better functional outcomes in severe TBI. Further high quality evidence is needed to confirm these findings. LEVEL OF EVIDENCE: level III TYPE OF STUDY: therapeutic study.

Language: en