Zusammenfassung
Hintergrund
Die Einhaltung einer Rettungszeit <60 min („golden hour“) wird unabhängig vom Rettungssystem gefordert. Ziel dieser Studie war es, den Einfluss der Rettungszeit auf das Überleben bei Schwerverletzten in Deutschland zu untersuchen.
Methode
Anhand des Traumaregisters der DGU wurde eine retrospektive Studie an 20.078 Patienten durchgeführt. In Klein- und Millionenstädten lag eine niedrigere Letalität vor, wobei Patienten in Millionen- und mittelgroßen Städten schwerer verletzt waren.
Ergebnisse
Anhand einer multivarianten Regressionsanalyse konnte kein Effekt für die Letalität in Abhängigkeit von der Dauer der Rettungszeit gezeigt werden. Bei längeren Rettungszeiten wurden signifikant mehr medizinische Maßnahmen durchgeführt und die Patienten waren schwerer verletzt.
Schlussfolgerung
Das Überleben schwerverletzter Patienten in Deutschland scheint nicht relevant von der Dauer der Rettungszeit beeinflusst zu werden, wobei bei längeren Rettungszeiten ein Selektionseffekt vorliegen kann. Präklinisch notwendige Maßnahmen zur Stabilisierung der Patienten sollten somit nicht zu Gunsten des Faktors Zeit unterlassen werden.
Abstract
Background
Independent of the rescue system type, a rescue time of less than 60 min for trauma patients is usually required and considered to be crucial for the outcome. The goal of this study was to investigate the impact of the rescue time on hospital survival in severely injured patients.
Methods
With the help of the German Trauma Registry of the DGU, the population and rescue time were systematically analyzed with regard to the survival rate. A lower mortality rate was observed with a higher injury severity in metropolitan cities compared to small towns.
Results
A multivariate regression analysis revealed no clinically relevant impact of the rescue time length in the German rescue system on survival. This can be explained by a higher amount of preclinical medical procedures during longer rescue times.
Conclusions
Within the German rescue system, the length of rescue time has no relevant impact on the survival of trauma patients admitted to a clinic. This could be explained by the higher numbers of preclinical measures and due to the limitations of a register study with selection bias. Therefore, we advocate that the necessary and suitable preclinical medical procedures be performed to stabilize the patient, even in cases that have exceeded the 60-min gold standard time window. In conclusion the “golden hour” concept today might better be interpreted as an individual and appropriate “golden period” of trauma.
Literatur
Frink M, Probst C, Hildebrand F et al (2007) The influence of transportation mode on mortality in polytraumatized patients. An analysis based on the German Trauma Registry. Unfallchirurg 110(4):334–340
Flohé S, Nast-Kolb D (2009) Surgical management of life-threatening injuries. Unfallchirurg 112(10):854–859
Edlich R, Wish J (2004) Maryland state police aviation division. A model emergency medical system for our nation. J Long Term Eff Med Implants 14(5):401–414
Cowley R, Hudson F, Scanlan E et al (1973) An economical and proved helicopter program for transporting the emergency critically ill and injured patient in Maryland. J Trauma 13(12):1029–1038
Sampalis J, Lavoie A, Salas M et al (1994) Determinants of on-scene time in injured patients treated by physicians at the site. Prehosp Disaster Med 9(3):178–189
Seamon M, Fisher C, Gaughan J et al (2007) Prehospital procedures before emergency department thoracotomy: „scoop and run“ saves lives. J Trauma 63(1):113–120
Di Bartolomeo S, Valent F, Rosolen V et al (2007) Are pre-hospital time and emergency department disposition time useful process indicators for trauma care in Italy? Injury 38(3):305–311
Petri R, Dyer A, Lumpkin J (1995) The effect of prehospital transport time on the mortality from traumatic injury. Prehosp Disaster Med 10(1):24–29
Lerner E, Moscati R (2001) The golden hour: scientific fact or medical „urban legend“? Acad Emerg Med 8(7):758–760
Sampalis J, Denis R, Lavoie A et al (1999) Trauma care regionalization: a process-outcome evaluation. J Trauma 46(4):565–581
Stiell I, Nesbitt L, Pickett W et al (2008) The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ 178 (9):1141–1152
Pepe P, Wyatt C, Bickell W et al (1987) The relationship between total prehospital time and outcome in hypotensive victims of penetrating injuries. Ann Emerg Med 16(3):293–297
Lerner E, Billittier A, Dorn J, Wu Y (2003) Is total out-of-hospital time a significant predictor of trauma patient mortality? Acad Emerg Med 10(9):949–954
Pons P, Markovchick V (2002) Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome? J Emerg Med 23(1):43–48
Osterwalder J (2002) Can the „golden hour of shock“ safely be extended in blunt polytrauma patients? Prospective cohort study at a level I hospital in eastern Switzerland. Prehosp Disaster Med 17(2):75–80
Feero S, Hedges J, Simmons E, Irwin L (1995) Does out-of-hospital EMS time affect trauma survival? Am J Emerg Med 13(2):133–135
Lefering R (2009) Development and validation of the Revised Injury Severity Classification (RISC) score for severely injured patients. Eur J Trauma Emerg Surg 35:437–447
Visser T, Pillay J, Koenderman L, Leenen LP (2008) Postinjury immune monitoring: can multiple organ failure be predicted? Curr Opin Crit Care 14(6):666–672
Sampalis J, Lavoie A, Williams J et al (1993) Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma 34(2):252–261
Berger E (2010) Nothing gold can stay? EMS crashes, lack of evicence bringing the golden hour concept under new scrutiny. Ann Emerg Med 56(5):A17–A19
Velden M van der, Ringburg A, Bergs E et al (2008) Prehospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care. Emerg Med J 25(7):444–449
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Kleber, C., Lefering, R., Kleber, A. et al. Rettungszeit und Überleben von Schwerverletzten in Deutschland. Unfallchirurg 116, 345–350 (2013). https://doi.org/10.1007/s00113-011-2132-5
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DOI: https://doi.org/10.1007/s00113-011-2132-5