Prehospital time and mortality in pediatric trauma
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In brief
In brief
This study challenges the traditional 'Golden Hour' concept in pediatric trauma by analyzing 60,670 patients from the ACS TQIP database. Using non-linear modeling, researchers found mortality risk was lowest at 45-60 minutes prehospital time, suggesting optimal transport windows differ from adult trauma paradigms.
- Mortality risk in pediatric trauma is lowest at 45-60 min prehospital time, challenging the traditional 'Golden Hour' concept.
- Prolonged prehospital time was associated with lower mortality, suggesting benefit from extended field stabilization.
- Non-linear relationship exists between transport time and outcomes—faster isn't always better in pediatric trauma.
- Optimal target is hospital transportation within 45 minutes while ensuring adequate prehospital treatment.
- Study of 60,670 pediatric patients shows need to balance rapid transport with quality field care at pediatric trauma centers.
Written by the GCMD Library team from the article.
Abstract
Purpose
The “Golden Hour” of transportation to a hospital has long been accepted as a central principal of trauma care. However, this has not been studied in pediatric populations. We assessed for non-linearity of the relationship between prehospital time and mortality in pediatric trauma patients, redefining the threshold at which reducing this time led to more favorable outcomes.
Methods
We performed an analysis of the 2017–2018 American College of Surgeons Trauma Quality Improvement Program, including trauma patients age < 18 years. We examined the association between prehospital time and odds of in-hospital mortality using linear, polynomial, and restricted cubic spline (RCS) models, ultimately selecting the non-linear RCS model as the best fit.
Results
60,670 patients were included in the study, of whom 1525 died and 3074 experienced complications. Prolonged prehospital time was associated with lower mortality and fewer complications. Both models demonstrated that mortality risk was lowest at 45–60 min, after which time was no longer associated with reduced probability of mortality.
Conclusions
The demonstration of a non-linear relationship between pre-hospital time and patient mortality is a novel finding. We highlight the need to improve prehospital treatment and access to pediatric trauma centers while aiming for hospital transportation within 45 min.