The Impact of Trauma System Development on Mortality and Emergency Medical Services Integration in Advancing Prehospital Care &ndash; A Systematic Review

Fouad Hamed Saeed Alamri; Mohanad Emad K Elyas; Mohammad Raja Aljehani; Ibrahim Abdullah Ibrahim Alsannat; Bandar Mohammad Abdullah Alkhathami; &rlm;Seham Ahmed Alanazi; &rlm;Alaa Ibrahim Rashad; Naifa Hail Alaida; &rlm;Abdulrahman Abdullah Alorf; &rlm;Salwa Rashed Alowaidan; &rlm;Ahmed Saleh Alghamdi; &rlm;Naif Saad Abdullah Alqahtani; &rlm;Mashael Ali Darbashi; &rlm;Noor Abdulaziz Alzuhair; &rlm;Abeer Saleh Alghamdi; &rlm;Sahar Adi Albogamy; &rlm;Mashael Shaya Aljabri; &rlm;Ghadeer Ghazi ALKhabbaz; &rlm;Muneef Olean Alharbi; &rlm;Faisal Ali AlKhaibari; &rlm;Hissah Abdulkarim Alqubaysi; &rlm;Dalal Mussad Albogami; &rlm;Khwlah Abdulaziz Alswaied

doi:10.25163/angiotherapy.7210130

Angiogenesis, Inflammation & Therapeutics | Online ISSN 2207-872X

REVIEWS (Open Access)

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The Impact of Trauma System Development on Mortality and Emergency Medical Services Integration in Advancing Prehospital Care – A Systematic Review

Fouad Hamed Saeed Alamri ¹, Mohanad Emad K Elyas ¹, Mohammad Raja Aljehani ¹, Ibrahim Abdullah Ibrahim Alsannat ¹, Bandar Mohammad Abdullah Alkhathami ¹, ‏Seham Ahmed Alanazi ¹, ‏Alaa Ibrahim Rashad ¹, Naifa Hail Alaida ¹, ‏Abdulrahman Abdullah Alorf ¹, ‏Salwa Rashed Alowaidan ¹, ‏Ahmed Saleh Alghamdi ¹, ‏Naif Saad Abdullah Alqahtani ¹, ‏Mashael Ali Darbashi ¹, ‏Noor Abdulaziz Alzuhair ¹, ‏Abeer Saleh Alghamdi ¹, ‏Sahar Adi Albogamy ¹, ‏Mashael Shaya Aljabri ¹, ‏Ghadeer Ghazi ALKhabbaz ¹, ‏Muneef Olean Alharbi ¹, ‏Faisal Ali AlKhaibari ¹, ‏Hissah Abdulkarim Alqubaysi ¹, ‏Dalal Mussad Albogami ¹, ‏Khwlah Abdulaziz Alswaied ¹

+ Author Affiliations

Journal of Angiotherapy 7(2) 1-8 https://doi.org/10.25163/angiotherapy.7210130

Submitted: 15 November 2023 Revised: 29 December 2023 Published: 30 December 2023

Abstract

Background: Injuries are a leading cause of global mortality and disability, accounting for approximately 9% of all deaths. Effective prehospital care protocols play a crucial role in reducing trauma-related mortality and morbidity. However, their impact varies depending on the developmental stage of trauma systems. This review evaluates the efficacy of prehospital interventions across different stages of trauma system maturity. Methods: A systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. Peer-reviewed articles published up to 2023 were retrieved from MEDLINE, EMBASE, and CINAHL databases. The analysis focused on studies assessing the impact of prehospital care protocols on trauma outcomes, particularly mortality reduction. Results: The findings indicate that well-structured trauma systems, integrating prehospital services, rehabilitation, and coordinated care, significantly reduce mortality and morbidity. Advanced prehospital diagnostic tools, including ultrasound, oxygen saturation monitoring, and capnography, have improved early trauma assessment. However, the accuracy of prehospital ultrasound varies widely (18.7%–68%), affecting its reliability. Rapid prehospital decompression for pneumothorax has shown substantial survival benefits, particularly in ventilated patients. Despite these advancements, inconsistencies in the application of prehospital protocols by emergency medical services (EMS) personnel highlight the need for standardized guidelines and enhanced training. Conclusion: The review underscores the critical role of prehospital care protocols in improving trauma outcomes. Continuous investment in trauma system development, EMS training, and the integration of innovative technologies is essential to optimizing prehospital care. Future research should focus on standardizing protocols and refining diagnostic strategies to enhance prehospital trauma management.

Keywords: Prehospital care, trauma systems, emergency medical services, survival rates, injury management, diagnostic tools.

References

Alharbi, R. J., Lewis, V., & Miller, C. (2021). A state-of-the-art review of factors that predict mortality among traumatic injury patients following a road traffic crash. Australasian Emergency Care. https://doi.org/10.1016/j.auec.2021.01.005

Alharbi, R. J., Lewis, V., Shrestha, S., & Miller, C. (2021). Effectiveness of trauma care systems at different stages of development in reducing mortality: A systematic review and meta-analysis protocol. BMJ Open, 11(6), e047439. https://doi.org/10.1136/bmjopen-2020-047439

Alharbi, R., Mosley, I., Miller, C., Hillel, S., & Lewis, V. (2019). Factors associated with physical, psychological, and functional outcomes in adult trauma patients following road traffic crash: A scoping literature review. Transportation Research Interdisciplinary Perspectives, 3, 100061. https://doi.org/10.1016/j.trip.2019.100061

Aufmkolk, M., Ruchholtz, S., Hering, M., Waydhas, C., Nast-Kolb, D., & Unfallchirurgie ANdDGf. (2003). Wertigkeit der subjektiven Einschätzung der Thoraxverletzungsschwere durch den Notarzt. Unfallchirurg, 106, 746-753. https://doi.org/10.1007/s00113-003-0640-7

Barton, E. (1999). Tension pneumothorax. Current Opinion in Pulmonary Medicine, 5, 269-274. https://doi.org/10.1097/00063198-199907000-00016

Barton, E., Epperson, M., Hoyt, D., Fortlage, D., & Rosen, P. (1995). Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews. Journal of Emergency Medicine, 13, 155-163. https://doi.org/10.1016/0736-4679(94)00135-9

Bauman, Z. M., Kulvatunyou, N., Joseph, B., Gries, L., O'Keeffe, T., Tang, A. L., et al. (2021). Randomized clinical trial of 14-French (14F) pigtail catheters versus 28-32F chest tubes in the management of patients with traumatic hemothorax and hemopneumothorax. World Journal of Surgery, 45(3), 880-886. https://doi.org/10.1007/s00268-020-05852-0

Beall, A. C. Jr., Bricker, D. L., Crawford, H. W., Noon, G. P., & De Bakey, M. E. (1968). Considerations in the management of penetrating thoracic trauma. Journal of Trauma, 8(3), 408-417. https://doi.org/10.1097/00005373-196805000-00007

Benns, M. V., Egger, M. E., Harbrecht, B. G., Franklin, G. A., Smith, J. W., Miller, K. R., et al. (2015). Does chest tube location matter? An analysis of chest tube position and the need for secondary interventions. Journal of Trauma and Acute Care Surgery, 78(2), 386-390. https://doi.org/10.1097/TA.0000000000000479

Bokhari, F., Brakenridge, S., Nagy, K., Roberts, R., Smith, R., Joseph, K., et al. (2002). Prospective evaluation of the sensitivity of physical examination in chest trauma. Journal of Trauma, 53(6), 1135-1138. https://doi.org/10.1097/00005373-200212000-00017

Brasel, K., Stafford, R., Weigelt, J., Tenquist, J., & Borgstrom, D. (1999). Treatment of occult pneumothoraces from blunt trauma. Journal of Trauma, 46, 987-990. https://doi.org/10.1097/00005373-199906000-00001

Bushby, N., Fitzgerald, M., Cameron, P., Marasco, S., Bystrzycki, A., Rosenfeld, V. J., et al. (2005). Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma. Emergency Medicine Australasia, 17(5-6), 443-449. https://doi.org/10.1111/j.1742-6723.2005.00775.x

Celso, B., Tepas, J., Langland-Orban, B., Pracht, E., Papa, L., Lottenberg, L., et al. (2006). A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. Journal of Trauma Acute Care Surgery, 60(2), 371-378. https://doi.org/10.1097/01.ta.0000197916.99629.eb

Chan, K. K., Joo, D. A., McRae, A. D., Takwoingi, Y., Premji, Z. A., Lang, E., et al. (2020). Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database of Systematic Reviews, 7, CD013031. https://doi.org/10.1002/14651858.CD013031.pub2

Chang, S. H., Kang, Y. N., Chiu, H. Y., & Chiu, Y. H. (2018). A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest, 153(5), 1201-1212. https://doi.org/10.1016/j.chest.2018.01.048

Chen, S. C., Markmann, J. F., Kauder, D. R., & Schwab, C. W. (1997). Hemopneumothorax missed by auscultation in penetrating chest injury. Journal of Trauma, 42(1), 86-89. https://doi.org/10.1097/00005373-199701000-00015

Claridge, J. A., Leukhardt, W. H., Golob, J. F., McCoy, A. M., & Malangoni, M. A. (2010). Moving beyond traditional measurement of mortality after injury: Evaluation of risks for late death. Journal of the American College of Surgeons, 210(5), 788-794. https://doi.org/10.1016/j.jamcollsurg.2009.12.035

Collins, J., Levine, G., & Waxman, K. (1992). Occult traumatic pneumothorax: Immediate tube thoracostomy versus expectant management. American Surgeon, 58, 743-746.

Committee on Trauma. (1997). Advanced Trauma Life Support (ATLS) - Reference manual. American College of Surgeons.

Cowley, R., & Scanlan, E. (1979). University trauma center: Operation, design, and staffing. American Surgeon, 45(2), 79-85.

Davis, D. P., Pettit, K., Rom, C. D., Poste, J. C., Sise, M. J., Hoyt, D. B., et al. (2005). The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehospital Emergency Care, 9(2), 191-197. https://doi.org/10.1080/10903120590924500

Deakin, C., Davies, G., & Wilson, A. (1995). Simple thoracostomy avoids chest drain insertion in prehospital trauma. Journal of Trauma, 39, 373-374. https://doi.org/10.1097/00005373-199508000-00031

Dominguez, K. M., Ekeh, A. P., Tchorz, K. M., Woods, R. J., Walusimbi, M. S., Saxe, J. M., et al. (2013). Is routine tube thoracostomy necessary after prehospital needle decompression for tension pneumothorax? American Journal of Surgery, 205(3), 329-332. https://doi.org/10.1016/j.amjsurg.2013.01.004

Enderson, B., Abdalla, R., Frame, S., Casey, M., Gould, H., & Maull, K. (1993). Tube thoracostomy for occult pneumothorax: A prospective randomized study of its use. Journal of Trauma, 35, 726-729. https://doi.org/10.1097/00005373-199311000-00013

Hirshberg, A., Thomson, S. R., & Huizinga, W. K. (1988). Reliability of physical examination in penetrating chest injuries. Injury, 19(6), 407-409. https://doi.org/10.1016/0020-1383(88)90135-0

Huber-Wagner, S., Lefering, R., Qvick, M., Kay, M. V., Paffrath, T., Mutschler, W., et al. (2007). Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation, 75, 276-285. https://doi.org/10.1016/j.resuscitation.2007.04.018

Hyde, J., Sykes, T., & Graham, T. (1997). Reducing morbidity from chest drains. BMJ, 314(7085), 914-915. https://doi.org/10.1136/bmj.314.7085.914

Inaba, K., Lustenberger, T., Recinos, G., Georgiou, C., Velmahos, G. C., Brown, C., et al. (2012). Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. Journal of Trauma and Acute Care Surgery, 72(2), 422-427. https://doi.org/10.1097/TA.0b013e3182452444

Johnson, G. (1996). Traumatic pneumothorax: Is a chest drain always necessary? Journal of Accident & Emergency Medicine, 13(3), 173-174. https://doi.org/10.1136/emj.13.3.173

Kirkpatrick, A. W., Rizoli, S., Ouellet, J. F., Roberts, D. J., Sirois, M., Ball, C. G., et al. (2013). Occult pneumothoraces in critical care: A prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. Journal of Trauma Acute Care Surgery, 74(3), 747-754. https://doi.org/10.1097/TA.0b013e3182827158

Kleber, C., Giesecke, M. T., Tsokos, M., Haas, N. P., & Buschmann, C. T. (2013). Trauma-related preventable deaths in Berlin 2010: Need to change prehospital management strategies and trauma management education. World Journal of Surgery, 37(5), 1154-1161. https://doi.org/10.1007/s00268-013-1964-2

Kulvatunyou, N., Erickson, L., Vijayasekaran, A., Gries, L., Joseph, B., Friese, R. F., et al. (2014). Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. British Journal of Surgery, 101(2), 17-22. https://doi.org/10.1002/bjs.9377

Laan, D. V., Vu, T. D., Thiels, C. A., Pandian, T. K., Schiller, H. J., Murad, M. H., et al. (2016). Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury, 47(4), 797-804. https://doi.org/10.1016/j.injury.2015.11.045

Leigh-Smith, S., & Harris, T. (2005). Tension pneumothorax - Time for a re-think. Emergency Medicine Journal, 22, 8-16. https://doi.org/10.1136/emj.2003.010421

Maezawa, T., Yanai, M., Huh, J. Y., & Ariyoshi, K. (2020). Effectiveness and safety of small-bore tube thoracostomy (≤20 Fr) for chest trauma patients: A retrospective observational study. American Journal of Emergency Medicine, 38(12), 2658-2660. https://doi.org/10.1016/j.ajem.2020.09.028

Mann, N. C., Mullins, R. J., MacKenzie, E. J., Jurkovich, G. J., & Mock, C. N. (1999). Systematic review of published evidence regarding trauma system effectiveness. Journal of Trauma, 47(3), S25-S33. https://doi.org/10.1097/00005373-199909001-00007

Martin, M., Satterly, S., Inaba, K., & Blair, K. (2012). Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Journal of Trauma and Acute Care Surgery, 73(6), 1412-1417. https://doi.org/10.1097/TA.0b013e31825ac511

Massarutti, D., Trillo, G., Berlot, G., Tomasini, A., Bacer, B., D'Orlando, L., et al. (2006). Simple thoracostomy in prehospital trauma management is safe and effective: A 2-year experience by helicopter emergency medical crews. European Journal of Emergency Medicine, 13(5), 276-280. https://doi.org/10.1097/00063110-200610000-00006

Mattson, M. E., Cai, R., & Woodward, A. (2015). Emergency department visits vs. fatalities among substance-impaired underage youths involved in motor vehicle crashes. Journal of Safety Research, 53, 45-51. https://doi.org/10.1016/j.jsr.2015.03.007

McConnell, K. J., Newgard, C. D., Mullins, R. J., Arthur, M., & Hedges, J. R. (2005). Mortality benefit of transfer to level I versus level II trauma centers for head-injured patients. Health Services Research, 40(2), 435-458. https://doi.org/10.1111/j.1475-6773.2005.0u367.x

McPherson, J. J., Feigin, D. S., & Bellamy, R. F. (2006). Prevalence of tension pneumothorax in fatally wounded combat casualties. Journal of Trauma, 60(3), 573-578. https://doi.org/10.1097/01.ta.0000209179.79946.92

Mendeloff, J. M., & Cayten, C. (1991). Trauma systems and public policy. Annual Review of Public Health, 12(1), 401-424. https://doi.org/10.1146/annurev.pu.12.050191.002153

Mistry, N., Bleetman, A., & Roberts, K. J. (2009). Chest decompression during the resuscitation of patients in prehospital traumatic cardiac arrest. Emergency Medicine Journal, 26(10), 738-740. https://doi.org/10.1136/emj.2008.065599

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Moore, F. O., Goslar, P. W., Coimbra, R., Velmahos, G., Brown, C. V., Coopwood, T. B. Jr., et al. (2011). Blunt traumatic occult pneumothorax: Is observation safe? Results of a prospective, AAST multicenter study. Journal of Trauma, 70(5), 1019-1023. https://doi.org/10.1097/TA.0b013e318213f727

Moore, L., Champion, H., Tardif, P.-A., Kuimi, B.-L., O'Reilly, G., Leppaniemi, A., et al. (2018). Impact of trauma system structure on injury outcomes: A systematic review and meta-analysis. World Journal of Surgery, 42(5), 1327-1339. https://doi.org/10.1007/s00268-017-4292-0

Nosher, J. L., & Siegel, R. (1993). Over-the-wire placement of large bore thoracostomy tubes. Cardiovascular and Interventional Radiology, 16(3), 195-197. https://doi.org/10.1007/BF02641893

Peitzman, A. B., Courcoulas, A. P., Stinson, C., Udekwu, A. O., Billiar, T. R., & Harbrecht, B. G. (1999). Trauma center maturation: Quantification of process and outcome. Annals of Surgery, 230(1), 87-94. https://doi.org/10.1097/00000658-199907000-00013

Press, G. M., Miller, S. K., Hassan, I. A., Alade, K. H., Camp, E., Junco, D. D., et al. (2014). Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. Journal of Emergency Medicine, 47(6), 638-645. https://doi.org/10.1016/j.jemermed.2014.07.056

Quick, J. A., Uhlich, R. M., Ahmad, S., Barnes, S. L., & Coughenour, J. P. (2016). In-flight ultrasound identification of pneumothorax. Emergency Radiology, 23(1), 3-7. https://doi.org/10.1007/s10140-015-1348-z

Remerand, F., Luce, V., Badachi, Y., Lu, Q., Bouhemad, B., & Rouby, J. J. (2007). Incidence of chest tube malposition in the critically ill: A prospective computed tomography study. Anesthesiology, 106(6), 1112-1119. https://doi.org/10.1097/01.anes.0000267594.80368.01

Roberts, D. J., Leigh-Smith, S., Faris, P. D., Blackmore, C., Ball, C. G., Robertson, H. L., et al. (2015). Clinical presentation of patients with tension pneumothorax: A systematic review. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001073

Rotondo, M. F., Cribari, C., & Smith, R. S. (2014). American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. Chicago: American College of Surgeons.

Rutherford, R. B., Hurt, H. H. Jr., Brickman, R. D., & Tubb, J. M. (1968). The pathophysiology of progressive, tension pneumothorax. Journal of Trauma, 8(2), 212-227. https://doi.org/10.1097/00005373-196803000-00009

Sampalis, J. S., Denis, R., Frechette, P., Brown, R., Fleiszer, D., & Mulder, D. (1997). Direct transport to tertiary trauma centers versus transfer from lower level facilities: Impact on mortality and morbidity among patients with major trauma. Journal of Trauma Acute Care Surgery, 43(2), 288-296. https://doi.org/10.1097/00005373-199708000-00014

Schmidt, U., Stalp, M., G. T., Blauth, M., Kimball, I., & Tscherne, H. (1998). Chest decompression of blunt chest injuries by physician in the field: Effectiveness and complications. Journal of Trauma, 44, 98-100. https://doi.org/10.1097/00005373-199801000-00010

Seid, M., Azazh, A., Enquselassie, F., & Yisma, E. (2015). Injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa. BMC Emergency Medicine, 15, 10. https://doi.org/10.1186/s12873-015-0035-4

Staub, L. J., Biscaro, R. R. M., Kaszubowski, E., & Maurici, R. (2018). Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax: A systematic review and meta-analysis. Injury, 49(3), 457-466. https://doi.org/10.1016/j.injury.2018.01.033

Symbas, P. (1989). Chest drainage tubes. Surgical Clinics of North America, 69, 41-46. https://doi.org/10.1016/S0039-6109(16)44733-X

Tanizaki, S., Maeda, S., Sera, M., Nagai, H., Hayashi, M., Azuma, H., et al. (2017). Small tube thoracostomy (20-22 Fr) in emergent management of chest trauma. Injury, 48(9), 1884-1887. https://doi.org/10.1016/j.injury.2017.06.021

Thal, A. P., & Quick, K. L. (1988). A guided chest tube for safe thoracostomy. Surgery, Gynecology & Obstetrics, 167(6), 517.

Thomson, S. R., Huizinga, W. K., & Hirshberg, A. (1990). Prospective study of the yield of physical examination compared with chest radiography in penetrating thoracic trauma. Thorax, 45(8), 616-619. https://doi.org/10.1136/thx.45.8.616

Tomlinson, M. A., & Treasure, T. (1997). Insertion of a chest drain: How to do it. British Journal of Hospital Medicine, 58(6), 248-252.

Tufanaru, C. M. Z., Aromataris, E., Campbell, J., & Hopp, L. (2017). Chapter 3: Systematic reviews of effectiveness. In E. Aromataris & Z. Munn (Eds.), Joanna Briggs Institute Reviewer's Manual (pp. 1-14). The Joanna Briggs Institute.

Waters, J. M., & Wells, C. H. (1973). The effects of a modern emergency medical care system in reducing automobile crash deaths. Journal of Trauma Acute Care Surgery, 13(7), 645-647. https://doi.org/10.1097/00005373-197307000-00009

Waydhas, C., & Sauerland, S. (2007). Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation, 72(1), 11-25. https://doi.org/10.1016/j.resuscitation.2006.06.025

World Health Organization. (2014). Injuries and violence: The facts 2014. WHO.

Yadav, K., Jalili, M., & Zehtabchi, S. (2010). Management of traumatic occult pneumothorax. Resuscitation, 81(9), 1063-1068. https://doi.org/10.1016/j.resuscitation.2010.04.030

Youmans, R. L., & Brose, R. A. (1970). A basis for classifying hospital emergency services. JAMA, 213(10), 1647-1651. https://doi.org/10.1001/jama.1970.03170360045008

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