The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study

Dominik A Jakob; Martin Müller; Sebastian Jud; Roland Albrecht; Wolf Hautz; Urs Pietsch

doi:10.1186/s13049-023-01107-8

The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study

Scand J Trauma Resusc Emerg Med. 2023 Aug 7;31(1):37. doi: 10.1186/s13049-023-01107-8.

Authors

Dominik A Jakob^#¹, Martin Müller^#², Sebastian Jud³, Roland Albrecht^{2

3

4}, Wolf Hautz^#², Urs Pietsch^#^{2

3

4}

Affiliations

¹ Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. Dominik.a.jakob@gmail.com.
² Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
³ Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁴ Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland.

^# Contributed equally.

Abstract

Background: Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies.

Methods: This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI).

Results: Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group.

Conclusion: Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.

Keywords: Chest decompression; Helicopter emergency medical services; Hemorrhage control; Prehospital management; Traumatic cardiac arrest.

MeSH terms

Adult
Air Ambulances*
Aircraft
Cohort Studies
Emergency Medical Services* / methods
Humans
Male
Retrospective Studies