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J Korean Soc Emerg Med > Volume 34(5); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(5): 403-412.
중증외상환자의 병원전 정맥로 확보 및 구급대 현장체류시각이 생존에 미치는 효과
안은선1 , 박정호1,2 , 김기홍1,2 , 이선영2,3 , 송경준2,4 , 신상도1,2
1서울대학교병원 응급의학과
2서울대학교병원 의생명연구원 응급의료연구실
3서울대학교병원 공공진료센터
4서울특별시 보라매병원 응급의학과
Prehospital intravenous catheter insertion, scene time interval, and their association with fatality in severe trauma patients with hypotension
Eun Seon Ahn1 , Jeong Ho Park1,2 , Ki Hong Kim1,2 , Sun Young Lee2,3 , Kyoung Jun Song2,4 , Sang Do Shin1,2
1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
2Laboratory of Emergency Medical Services, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
3Comprehensive Community Care Center, Seoul National University Hospital, Seoul, Korea
4Department of Emergency Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
Correspondence  Jeong Ho Park ,Tel: 02-2072-1800, Fax: 02-741-7855, Email: timthe@gmail.com,
Received: September 14, 2022; Revised: November 26, 2022   Accepted: December 6, 2022.  Published online: October 31, 2023.
ABSTRACT
Objective:
To investigate the association between prehospital intravenous (IV) catheter insertion, scene time interval (STI), and fatality in severe trauma patients with hypotension.
Method:
This study used a 2018 nationwide emergency medical services (EMS)-based trauma database. Adult severe trauma patients whose injury severity score was above or equal to 16 and whose initial systolic blood pressure was under 90 mmHg were included. Patients were divided into four groups based on whether a prehospital IV catheter was inserted and STI was within 10 minutes-group 1, IV catheter (+) and STI <10 minutes; group 2, IV catheter (+) and STI ≥10 minutes; group 3, IV catheter (-) and STI <10 minutes; and group 4, IV catheter (-) and STI ≥10 minutes. W-score (additional survivor expected for every 100 patients) was used as the outcome index.
Results:
Among the 30,034 EMS-treated severe trauma patients, 550 patients were analyzed. Group 1 comprised 289 patients (53%), group 2, 159 (29%), group 3, 65 (12%), and group 4, 37 (6.7%). The case fatality rate was 104 (36%) in group 1, 38 (25%) in group 2, 23 (35%) in group 3, and 11 (30%) in group 4. The W-score (95% confidence interval) was 2.42 (2.38 to 2.99) in group 1, 1.89 (1.83 to 2.90) in group 2, -4.62 (-4.70 to -2.94) in group 3, and -5.41 (-5.52 to -3.03) in group 4.
Conclusion:
Prehospital IV catheter insertion in severe trauma patients with hypotension is beneficial for survival, and the positive effect was prominent when STI was short.
Key words: Outcome; Mortality; Emergency medical services; Peripheral catheterization
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