The OPALS major trauma Study: impact of advanced life-support on survival and morbidity

被引：206

作者：

Stiell, Ian G. ^{[1
,3
]}

Nesbitt, Lisa P. ^{[3
]}

Pickett, William ^{[4
]}

Munkley, Douglas ^{[5
]}

Spaite, Daniel W. ^{[6
]}

Banek, Jane ^{[3
]}

Field, Brian ^{[7
]}

Luinstra-Toohey, Lorraine ^{[5
]}

Maloney, Justin ^{[8
]}

Dreyer, Jon ^{[9
]}

Lyver, Marion ^{[10
]}

Campeau, Tony ^{[11
]}

Wells, George A. ^{[2
,3
]}

机构：

[1] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada

[2] Univ Ottawa, Dept Epidemiol & Community Hlth, Ottawa, ON, Canada

[3] Ottawa Hlth Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[4] Queens Univ, Dept Emergency Med, Kingston, ON, Canada

[5] Greater Niagara Base Hosp, Niagara Falls, ON, Canada

[6] Univ Arizona, Dept Emergency Med, Tucson, AZ USA

[7] Interdev Technol, Toronto, ON, Canada

[8] Ottawa Base Hosp Program, Ottawa, ON, Canada

[9] Univ Western Ontario, Div Emergency Med, London, ON, Canada

[10] McMaster Univ, Dept Family Med, Hamilton, ON L8S 4L8, Canada

[11] Ontario Minist Hlth & Long Term Care, Emergency Hlth Serv Campeau, Toronto, ON, Canada

来源：

CANADIAN MEDICAL ASSOCIATION JOURNAL | 2008年 / 178卷 / 09期

关键词：

D O I：

10.1503/cmaj.071154

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established Methods: The Ontario Prehospital Advanced Life Support ( OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase ( during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results: Among the 2867 patients enrolled in the basic life-support (n= 1373) and advanced life-support ( n= 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score ( 24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p=0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p= 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p= 0.16). Interpretation: The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.

引用

页码：1141 / 1152

页数：12

共 40 条

[1]

[Anonymous], 2002, ADV DATA

[2] IMMEDIATE VERSUS DELAYED FLUID RESUSCITATION FOR HYPOTENSIVE PATIENTS WITH PENETRATING TORSO INJURIES [J].

BICKELL, WH ;

WALL, MJ ;

PEPE, PE ;

MARTIN, RR ;

GINGER, VF ;

ALLEN, MK ;

MATTOX, KL .

NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (17) :1105-1109

[3] Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury [J].

Bochicchio, GV ;

Ilahi, O ;

Joshi, M ;

Bochicchio, K ;

Scalea, TM .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (02) :307-311

[4] EVALUATING TRAUMA CARE - THE TRISS METHOD [J].

BOYD, CR ;

TOLSON, MA ;

COPES, WS .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1987, 27 (04) :370-378

[5] The use of neuromuscular blocking agents to facilitate prehospital intuhation does not impair outcome after traumatic brain injury [J].

Bulger, EM ;

Copass, MK ;

Sabath, DR ;

Maier, RV ;

Jurkovich, GJ .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2005, 58 (04) :718-723

[6] Scientific priorities and strategic planning for resuscitation research and life saving therapy following traumatic injury: Report of the pulse trauma work group [J].

Carrico, CJ ;

Holcomb, JB ;

Chaudry, IH .

SHOCK, 2002, 17 (03) :165-168

[7] BASIC LIFE-SUPPORT VERSUS ADVANCED LIFE-SUPPORT FOR INJURED PATIENTS WITH AN INJURY SEVERITY SCORE OF 10 OR MORE [J].

CAYTEN, CG ;

MURPHY, JG ;

STAHL, WM ;

TORTELLA, BJ ;

JACOBS, LM ;

GOMEZ, GA ;

ESPOSITO, TJ .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1993, 35 (03) :460-467

[8] A REVISION OF THE TRAUMA SCORE [J].

CHAMPION, HR ;

SACCO, WJ ;

COPES, WS ;

GANN, DS ;

GENNARELLI, TA ;

FLANAGAN, ME .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1989, 29 (05) :623-629

[9] THE MAJOR TRAUMA OUTCOME STUDY - ESTABLISHING NATIONAL NORMS FOR TRAUMA CARE [J].

CHAMPION, HR ;

COPES, WS ;

SACCO, WJ ;

LAWNICK, MM ;

KEAST, SL ;

BAIN, LW ;

FLANAGAN, ME ;

FREY, CF .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1990, 30 (11) :1356-1365

[10] Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury - A randomized controlled trial [J].

Cooper, DJ ;

Myles, PS ;

McDermott, FT ;

Murray, LJ ;

Laidlaw, J ;

Cooper, G ;

Tremayne, AB ;

Bernard, SS ;

Ponsford, J .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (11) :1350-1357

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