Mortality of blunt polytrauma: a comparison between emergency physicians and emergency medical technicians--prospective cohort study at a level I hospital in eastern Switzerland - Osterwalder, J. J. (J Trauma, 2003)
BACKGROUND: The role of prehospital basic life support as opposed to prehospital advanced life support and the best qualifications for emergency personnel are controversial. Our objective was to establish whether the prehospital deployment of emergency physicians (EPs) rather than emergency medical technicians (EMTs) decreased mortality in blunt polytrauma patients. METHODS: In a prospective, observational cohort study conducted between 1990 and 1996, we used the A Severity Characterization of Trauma score to compare the actual mortality with the predicted mortality in 71 blunt polytrauma patients, 63 treated by EMTs alone and 8 treated also by anesthetic nurses. The same comparison was conducted in 196 blunt polytrauma patients treated by EPs together with EMTs or paramedics. Multivariate logistic regression analysis was conducted to test for any confounding factors and bias, and for the identification of factors associated with mortality. Inclusion criteria were blunt trauma at a minimum of two body sites, an Injury Severity Score of 8 or more, and direct admission to our trauma center. RESULTS: The mortality in patients treated by EPs was 11.2% (22 of 196) and was statistically not significantly lower than the 14.1% calculated for the patients treated without EP involvement (10 of 71). In the group treated by EPs, there were 1.3 (95% confidence interval [CI], -5.9-8.5), or 6%, fewer deaths than would have been expected on the basis of the results of the Major Trauma Outcome Study (p = 0.734). In contrast, in the group treated without EP involvement, there were 3.4 (95% CI, -0.2-7), or 34%, more deaths than predicted (p = 0.066). This trend was confirmed by multivariate logistic regression, which showed a significant mortality odds ratio of 37 (95% CI, 2-749) for the EMT group as compared with the EP group. CONCLUSION: In contrast with the deployment of EPs, care of blunt polytrauma patients by EMTs showed a statistical trend to a higher mortality than predicted and also a significantly higher risk of mortality. It is likely that the consistent deployment of EPs for moderate to severe blunt polytrauma in our catchment area might prevent between 0% and 23% of all deaths from blunt polytrauma or, in absolute terms, up to 1 death per year or 0 to 9.9 per 100 patients treated by an EP instead of an EMT.
Keywords: journalArticle; *Emergency Medical Services; *Emergency Medical Technicians; *Physicians; Adult; Clinical Competence; Cohort Studies; Female; Humans; Injury Severity Score; Male; Multiple Trauma/*mortality/*therapy; Prospective Studies; Switzerland; Wounds, Nonpenetrating/*mortality/*therapy