Lack of emergency medical services documentation is associated with poor patient outcomes: a validation of audit filters for prehospital trauma care

J Am Coll Surg. 2010 Feb;210(2):220-7. doi: 10.1016/j.jamcollsurg.2009.10.008. Epub 2009 Dec 4.


Background: Our previous Delphi study identified several audit filters considered sensitive to deviations in prehospital trauma care and potentially useful in conducting performance improvement, a process currently recommended by the American College of Surgeons Committee on Trauma. This study validates 2 of those proposed audit filters.

Study design: We studied 4,744 trauma patients using the electronic records of the Central Region Trauma registry and Emergency Medical Services (EMS) patient logs for the period January 1, 2002, to December 31, 2004. We studied whether requests by on-scene Basic Life Support (BLS) for Advanced Life Support (ALS) assistance or failure by EMS personnel to record basic patient physiology at the scene was associated with increased in-hospital mortality. We performed multivariate analyses, including a propensity score quintile approach, adjusting for differences in case mix and clustering by hospital.

Results: Overall mortality was 6.1%. A total of 28.2% (n = 1,337) of EMS records were missing patient scene physiologic data. Multivariate analysis revealed that patients missing 1 or more measures of patient physiology at the scene had increased risk of death (adjusted odds ratio = 2.15; 95% CI, 1.13 to 4.10). In 17.4% (n = 402) of cases BLS requested ALS assistance. Patients for whom BLS requested ALS had a similar risk of death as patients for whom ALS was initially dispatched (odds ratio = 1.04; 95% CI, 0.51 to 2.15).

Conclusions: Failure of EMS to document basic measures of scene physiology is associated with increased mortality. This deviation in care can serve as a sensitive audit filter for performance improvement. The need by BLS for ALS assistance was not associated with increased mortality.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Cardiopulmonary Resuscitation*
  • Cohort Studies
  • Documentation*
  • Electronic Health Records*
  • Emergency Medical Services / organization & administration*
  • Female
  • Forms and Records Control / organization & administration
  • Humans
  • Male
  • Medical Audit
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • Wounds and Injuries / diagnosis*
  • Wounds and Injuries / etiology
  • Wounds and Injuries / therapy*