Comparison of Mortality Due to Severe Multiple Trauma in Two Comprehensive Models of Emergency Care: Atlantic Pyrenees (France) and Navarra (Spain)

José Luis Gómez de Segura Nieva, Mercedes Marraco Boncompte, Alfredo Echarri Sucunza, Clint Luise Jean Louis, María Seguí-Gómez, Tomás Belzunegui Otano

Research output: Contribution to journalArticle

Abstract

Background: Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of "comprehensive care" can prevent deaths and disabilities as well as limit the severity and pain caused by trauma. Objective: To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain. Material and Methods: A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center "112," pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. Results: There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1-13.1), RTS (OR 0.58, 95% CI 0.5-0.7), and ISS score (OR 1.05, 95% CI 1.0-1.1). Conclusion: Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others.

Original languageEnglish (US)
Pages (from-to)189-200
Number of pages12
JournalJournal of Emergency Medicine
Volume37
Issue number2
DOIs
StatePublished - Aug 2009
Externally publishedYes

Keywords

  • comprehensive emergency care systems
  • mortality
  • severe multiple trauma
  • trauma systems

ASJC Scopus subject areas

  • Emergency Medicine

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