Journal of Trauma and Acute Care Surgery, Publish Ahead of Print DOI: 10.1097/TA.0000000000000999
Not All Prehospital Time is Equal: Influence of Scene Time on Mortality
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Joshua B. Brown, MD, MSc1 Matthew R. Rosengart, MD, MPH1 Raquel M. Forsythe, MD1 Benjamin R. Reynolds, MPAS, PA-C1 Mark L. Gestring, MD2 William M. Hallinan, RN, MS, EMT-P2 Andrew B. Peitzman, MD1 Timothy R. Billiar, MD1 Jason L. Sperry, MD, MPH1
Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh
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Medical Center, Pittsburgh, Pennsylvania 15213
Division of Acute Care Surgery, Department of Surgery, University of Rochester Medical
Center, Rochester, New York 14642
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Submitted: November 30, 2015 Revised: January 20, 2016 Accepted: January 22, 2016
Correspondence and Reprints
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Joshua B. Brown, MD, MSc
Division of Trauma and General Surgery Department of Surgery University of Pittsburgh Medical Center 200 Lothrop Street Pittsburgh, Pennsylvania 15213 Phone: (716) 400-2471 email:
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Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
No funding or support was directly received to perform the current study. Dr. Brown receives support from an institutional T-32 Ruth L. Kischstein National Research Service Award training grant (5-T32-GM-008516-20) from the National Institutes of Health.
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There are no conflicts of interest for the current study
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This paper was presented at the 29th annual meeting of the Eastern Association for the Surgery of
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Trauma, January 12–16, 2016, in San Antonio, Texas.
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Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Background: Trauma is time-sensitive and minimizing prehospital (PH) time is appealing. However, most studies have not linked increasing PH time with worse outcomes, as raw PH times are highly variable. It is unclear whether specific PH time patterns affect outcomes. Our objective was to evaluate the association of PH time interval distribution with mortality.
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Methods: Patients transported by EMS in the Pennsylvania trauma registry 2000-2013 with total prehospital time (TPT)≥20min were included. TPT was divided into three PH time intervals:
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response, scene, and transport time. The number of minutes in each PH time interval was divided by TPT to determine the relative proportion each interval contributed to TPT. A prolonged interval was defined as any one PH interval contributing≥50% of TPT. Patients were classified
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by prolonged PH interval or no prolonged PH interval (all intervals