Background: Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for\nadults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patient\noutcomes for major trauma within one Regional Trauma Network.\nMethod: Secondary analysis of pre-hospital audit data and patient outcome data from the Trauma Audit Research\nNetwork (TARN) was undertaken. The primary outcome used in analysis was ââ?¬Ë?Status at Dischargeââ?¬â?¢ (alive/deceased).\nIndependent variables considered included ââ?¬Ë?Casualty Characteristicsââ?¬â?¢ such as mechanism of injury (MOI), age, and\nphysiological measurements, as well as ââ?¬Ë?Response Characteristicsââ?¬â?¢ such as response timings and skill mix. Binary\nLogistic Regression analysis using the ââ?¬Ë?forward stepwiseââ?¬â?¢ method was undertaken for physiological measures taken\nat the scene.\nResults: The study analysed 1033 major trauma records (mean age of 38.5 years, SD 21.5, 95% CI 37ââ?¬â??40). Adults\ncomprised 82.6% of the sample (n = 853), whilst 12.9% of the sample were children (n = 133). Men comprised 68.\n5% of the sample (n = 708) in comparison to 28.8% women (n = 298).\nGlasgow Coma Score (GCS) (p < 0.000), Respiration Rate (p < 0.001) and Age (p < 0.000), were all significant when\nassociated with the outcome ââ?¬Ë?Status at Dischargeââ?¬â?¢ (alive/deceased).\nIsolated bivariate associations provided tentative support for response characteristics such as existing dispatching\npractices and the value of rapid crew arrival. However, these measurements appear to be of limited utility in\npredictive modelling of outcomes.\nDiscussion: The complexity of physiological indices potentially complicate their predictive utility e.g. whilst a Systolic\nBlood Pressure (SBP) of < 90 mmHg serves as a trigger for bypass to a Major Trauma Centre, the utility of this\nobservation is nullified in cases of Traumatic Brain Injury.\nAnalysis suggested that as people age, outcomes from major trauma significantly worsened. This finding is consistent\nwith existing research highlighting the relationship between trauma in elderly patients and poorer outcomes.\nConclusion: Findings lend further validity to GCS, Respiration Rate and Age as predictive triggers for transport to a\nMajor Trauma Centre. Analysis of interactions between response times, skill mix and triage demand further exploration\nbut tentatively support the ââ?¬Ë?Golden Hourââ?¬â?¢ concept and suggest a potential ââ?¬Ë?load and go and play on the wayââ?¬â?¢ approach.
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