학술논문
Association Between Ambulance Station Case Volume and Clinical Outcomes in Moderate to Severe Trauma.
Document Type
Academic Journal
Author
Jang J; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Kim KH; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.; Park JH; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.; Jeong J; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Department of Emergency Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea.; Ro YS; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.; Song KJ; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Department of Emergency Medicine, Seoul Metropolitan Boramae Medical Center, Seoul, South Korea.; Shin SD; Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.; Department of Emergency Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea.
Source
Publisher: Informa Healthcare Country of Publication: England NLM ID: 9703530 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1545-0066 (Electronic) Linking ISSN: 10903127 NLM ISO Abbreviation: Prehosp Emerg Care Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: The effect of the case volume of emergency medical services (EMS) on the clinical outcomes of trauma is uncertain. The purpose of this study was to evaluate the association between the case volume of an ambulance station and clinical outcomes in moderate to severe trauma patients.
Methods: Adult trauma patients with injury severity scores greater than 8 who were transported by the EMS between 2018 and 2019 were analyzed. The main exposure was the annual case volume of moderate to severe trauma at the ambulance station where the patient-transporting ambulance was based: low-volume (less than 60 cases), intermediate-volume (between 60 and 89 cases), and high-volume (equal or greater than 90 cases). The primary outcome was in-hospital mortality. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs), with the high-volume group used as the reference.
Results: In total, 21,498 trauma patients were analyzed. The high-volume group exhibited lower in-hospital mortality, 447 (9.0%), compared to 867 (14.1%) in the intermediate-volume group and 1,458 (14.1%) in the low-volume group. There were a significantly higher odds of in-hospital mortality: the low-volume group (AOR 95% CI: 1.20 (0.95-1.51)) and intermediate-volume group (AOR 95% CI: 1.29 (1.02-1.64)) when compared to the high-volume group.
Conclusions: The case volume at an ambulance station is associated with in-hospital mortality in patients with moderate to severe trauma. These results should be considered when constructing an EMS system and education program for prehospital trauma care.
Methods: Adult trauma patients with injury severity scores greater than 8 who were transported by the EMS between 2018 and 2019 were analyzed. The main exposure was the annual case volume of moderate to severe trauma at the ambulance station where the patient-transporting ambulance was based: low-volume (less than 60 cases), intermediate-volume (between 60 and 89 cases), and high-volume (equal or greater than 90 cases). The primary outcome was in-hospital mortality. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs), with the high-volume group used as the reference.
Results: In total, 21,498 trauma patients were analyzed. The high-volume group exhibited lower in-hospital mortality, 447 (9.0%), compared to 867 (14.1%) in the intermediate-volume group and 1,458 (14.1%) in the low-volume group. There were a significantly higher odds of in-hospital mortality: the low-volume group (AOR 95% CI: 1.20 (0.95-1.51)) and intermediate-volume group (AOR 95% CI: 1.29 (1.02-1.64)) when compared to the high-volume group.
Conclusions: The case volume at an ambulance station is associated with in-hospital mortality in patients with moderate to severe trauma. These results should be considered when constructing an EMS system and education program for prehospital trauma care.