ID | 63733 |
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Author |
Nishimura, Takeshi
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Nojima, Tsuyoshi
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Naito, Hiromichi
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Ishihara, Satoshi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center
Nakayama, Shinichi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center
Nakao, Atsunori
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Abstract | Objective
Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients. Methods We retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS). Results Overall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99–1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01–1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97–1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS <16 (adjusted OR 1.53, 95% CI 1.10–2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07–1.52), during the earlier study period (2004–2008, adjusted OR 1.50, 95% CI 1.14–1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03–1.41). Conclusions Dispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions. |
Keywords | JTDB
Prehospital
Emergency life-saving technician
Trauma
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Published Date | 2022-06
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Publication Title |
The American Journal of Emergency Medicine
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Volume | volume56
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Publisher | Elsevier BV
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Start Page | 218
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End Page | 222
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ISSN | 0735-6757
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Content Type |
Journal Article
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language |
English
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OAI-PMH Set |
岡山大学
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Copyright Holders | © 2022 The Authors.
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File Version | publisher
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Related Url | isVersionOf https://doi.org/10.1016/j.ajem.2022.04.004
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License | http://creativecommons.org/licenses/by-nc-nd/4.0/
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