Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study

Autoři: Chi-Hsin Chen aff001;  Sang Do Shin aff002;  Jen-Tang Sun aff003;  Sabariah Faizah Jamaluddin aff004;  Hideharu Tanaka aff005;  Kyoung Jun Song aff002;  Kentaro Kajino aff006;  Akio Kimura aff007;  Edward Pei-Chuan Huang aff001;  Ming-Ju Hsieh aff008;  Matthew Huei-Ming Ma aff008;  Wen-Chu Chiang aff008
Působiště autorů: Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan aff001;  Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea aff002;  Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan aff003;  Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia aff004;  Graduate School of Emergency Medical Service System, Kokushikan University, Tokyo, Japan aff005;  Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan aff006;  Department of Emergency Medicine and Critical Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan aff007;  Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan aff008;  Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan aff009
Vyšlo v časopise: Association between prehospital time and outcome of trauma patients in 4 Asian countries: A cross-national, multicenter cohort study. PLoS Med 17(10): e32767. doi:10.1371/journal.pmed.1003360
Kategorie: Research Article



Whether rapid transportation can benefit patients with trauma remains controversial. We determined the association between prehospital time and outcome to explore the concept of the “golden hour” for injured patients.

Methods and findings

We conducted a retrospective cohort study of trauma patients transported from the scene to hospitals by emergency medical service (EMS) from January 1, 2016, to November 30, 2018, using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time intervals were categorized into response time (RT), scene to hospital time (SH), and total prehospital time (TPT). The outcomes were 30-day mortality and functional status at hospital discharge. Multivariable logistic regression was used to investigate the association of prehospital time and outcomes to adjust for factors including age, sex, mechanism and type of injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and prehospital interventions. Overall, 24,365 patients from 4 countries (645 patients from Japan, 16,476 patients from Korea, 5,358 patients from Malaysia, and 1,886 patients from Taiwan) were included in the analysis. Among included patients, the median age was 45 years (lower quartile [Q1]–upper quartile [Q3]: 25–62), and 15,498 (63.6%) patients were male. Median (Q1–Q3) RT, SH, and TPT were 20 (Q1–Q3: 12–39), 21 (Q1–Q3: 16–29), and 47 (Q1–Q3: 32–60) minutes, respectively. In all, 280 patients (1.1%) died within 30 days after injury. Prehospital time intervals were not associated with 30-day mortality. The adjusted odds ratios (aORs) per 10 minutes of RT, SH, and TPT were 0.99 (95% CI 0.92–1.06, p = 0.740), 1.08 (95% CI 1.00–1.17, p = 0.065), and 1.03 (95% CI 0.98–1.09, p = 0.236), respectively. However, long prehospital time was detrimental to functional survival. The aORs of RT, SH, and TPT per 10-minute delay were 1.06 (95% CI 1.04–1.08, p < 0.001), 1.05 (95% CI 1.01–1.08, p = 0.007), and 1.06 (95% CI 1.04–1.08, p < 0.001), respectively. The key limitation of our study is the missing data inherent to the retrospective design. Another major limitation is the aggregate nature of the data from different countries and unaccounted confounders such as in-hospital management.


Longer prehospital time was not associated with an increased risk of 30-day mortality, but it may be associated with increased risk of poor functional outcomes in injured patients. This finding supports the concept of the “golden hour” for trauma patients during prehospital care in the countries studied.

Klíčová slova:

Asia – Cohort studies – Critical care and emergency medicine – Resuscitation – Transportation – Traumatic brain injury – Traumatic injury – Traumatic injury risk factors


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