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Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data

Ashley Akbari Orcid Logo, Jane Lyons, B. J. Gabbe, D. Rawlinson, D. Lockey, Rich Fry Orcid Logo, Ronan Lyons Orcid Logo

Anaesthesia, Volume: 76, Issue: 11

Swansea University Authors: Ashley Akbari Orcid Logo, Jane Lyons, Rich Fry Orcid Logo, Ronan Lyons Orcid Logo

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DOI (Published version): 10.1111/anae.15457

Abstract

The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical...

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Published in: Anaesthesia
ISSN: 0003-2409 1365-2044
Published: Wiley 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa56616
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This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score &#x2265; 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score &#x2265; 16 and Glasgow coma scale &#x2264; 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41&#x2013;0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury.</abstract><type>Journal Article</type><journal>Anaesthesia</journal><volume>76</volume><journalNumber>11</journalNumber><paginationStart/><paginationEnd/><publisher>Wiley</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0003-2409</issnPrint><issnElectronic>1365-2044</issnElectronic><keywords>Wales, Emergency Medicine, Data</keywords><publishedDay>29</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-03-29</publishedDate><doi>10.1111/anae.15457</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>Health Data Research UK. 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spelling 2021-11-08T16:10:13.1027391 v2 56616 2021-04-04 Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 1b74fa5125a88451c52c45bcf20e0b47 Jane Lyons Jane Lyons true false d499b898d447b62c81b2c122598870e0 0000-0002-7968-6679 Rich Fry Rich Fry true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2021-04-04 HDAT The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score ≥ 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score ≥ 16 and Glasgow coma scale ≤ 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41–0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury. Journal Article Anaesthesia 76 11 Wiley 0003-2409 1365-2044 Wales, Emergency Medicine, Data 29 3 2021 2021-03-29 10.1111/anae.15457 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU Library paid the OA fee (TA Institutional Deal) Health Data Research UK. Grant Number: HDR-9006 NHS Wales UK Medical Research Council Engineering and Physical Sciences Research Council Economic and Social Research Council National Institute for Health Research (England) Chief Scientist Office of the Scottish Government Health and Social Care 2021-11-08T16:10:13.1027391 2021-04-04T11:30:54.7229009 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Ashley Akbari 0000-0003-0814-0801 1 Jane Lyons 2 B. J. Gabbe 3 D. Rawlinson 4 D. Lockey 5 Rich Fry 0000-0002-7968-6679 6 Ronan Lyons 0000-0001-5225-000X 7 56616__19761__8c6edaf906b846a69c8b19bdb94d015d.pdf 56616.pdf 2021-04-27T10:13:48.8355488 Output 691656 application/pdf Version of Record true © 2021 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License true eng http://creativecommons.org/licenses/by-nc/4.0/
title Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
spellingShingle Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
Ashley Akbari
Jane Lyons
Rich Fry
Ronan Lyons
title_short Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
title_full Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
title_fullStr Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
title_full_unstemmed Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
title_sort Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data
author_id_str_mv aa1b025ec0243f708bb5eb0a93d6fb52
1b74fa5125a88451c52c45bcf20e0b47
d499b898d447b62c81b2c122598870e0
83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
1b74fa5125a88451c52c45bcf20e0b47_***_Jane Lyons
d499b898d447b62c81b2c122598870e0_***_Rich Fry
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Ashley Akbari
Jane Lyons
Rich Fry
Ronan Lyons
author2 Ashley Akbari
Jane Lyons
B. J. Gabbe
D. Rawlinson
D. Lockey
Rich Fry
Ronan Lyons
format Journal article
container_title Anaesthesia
container_volume 76
container_issue 11
publishDate 2021
institution Swansea University
issn 0003-2409
1365-2044
doi_str_mv 10.1111/anae.15457
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score ≥ 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score ≥ 16 and Glasgow coma scale ≤ 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41–0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury.
published_date 2021-03-29T04:11:42Z
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