Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: a retrospective analysis of the Japanese nationwide trauma registry

Abstract Background Although the results of previous studies suggested effectiveness physician-led prehospital trauma management, it has been uncertain because limited number high-quality studies. Furthermore, advantage management might have overestimated due to shortened time by helicopter transportation in some The present study aimed evaluate effect independent time. Also, subgroup analysis was performed explore subpopulation that especially benefit from management. Methods This retrospective cohort analyzed data Japan’s nationwide registry. Severe blunt patients, defined Injury Severity Score (ISS) ?16, who were transported directly a hospital between April 2009 and March 2019 evaluated. In-hospital mortality compared groups dichotomized occupation primary healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. score calculated potential confounders including patient demographics, mechanism injury, vital signs at scene ISS, total injury arrival. Subpopulations explored assessing interaction effects characteristics. Results A 30,551 patients (physician-led: 2976, paramedic-led: 27,575) eligible for analysis, whom 2690 pairs 2690, 10,760) generated compared. Physician-led group showed significantly decreased in-hospital than paramedic-led (in-hospital mortality: 387 [14.4%] 1718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p 0.044). Patients with age < 65 years, ISS ?25, Abbreviated Scale pelvis lower extremities ?3, 60 min likely Conclusions associated reduced findings exploratory would be useful future research establish efficient dispatch system team.