Prehospital intravenous catheter insertion, scene time interval, and their association with fatality in severe trauma patients with hypotension

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