Inclusion of prehospital mortality statistics in severe trauma registries: a study of the influence of inclusion on trauma lethality rates and survival prediction
Fortún Moral M, Ali Ali B, Montes Fernández LM, Rey Pecharromán JM, Teijeira Álvarez R, Belzunegui Otano T
Affiliation of the authors
Servicio de Urgencias y UVIMóvil. Hospital de Tudela, Navarra, Spain. Servicio de Urgencias. Complejo Hospitalario de Navarra, Pamplona, Spain. Servicio Navarro de Salud, Spain. Instituto Navarro de Medicina Legal, Spain.
Fortún Moral M, Ali Ali B, Montes Fernández LM, Rey Pecharromán JM, Teijeira Álvarez R, Belzunegui Otano T. Inclusion of prehospital mortality statistics in severe trauma registries: a study of the influence of inclusion on trauma lethality rates and survival prediction. Emergencias. 2016;28:173-8
Summary
Objectives.
To compare the frequency and characteristics of prehospital and hospital deaths and assess whether injury severity and age can predict mortality when prehospital deaths are included or excluded from total mortality.
Methods.
Descriptive analysis of a retrospective cohort of 918 patients with multiple injuries attended by emergency medical services in Navarre, Spain, in 2010–2013. We analyzed prehospital and hospital deaths by cause of injuries and developed and compared the precision of logistic regression models to predict mortality.
Results.
Most deaths occurred before arrival at a hospital. Three quarters of prehospital deaths occurred in patients under the age of 65 years. When prehospital deaths were included in the analysis, the lethality rate after traffic accidents rose from 16% to 42%; lethality from firearm injuries rose from 13% to 70%. When the model using the new
injury severity score and age as independent variables was asked to predict survival with and without data for deaths at the scene or during transfer to a hospital, the model’s performance differed only slightly.
Conclusions.
Most deaths from injuries occur before patients reach a hospital. The main characteristics of prehospital and hospital deaths differ. Including data for prehospital deaths in regression models does not change survival prediction based on injury severity and age.
