Background: The 'golden hour' is a well-known concept, suggesting that shortening time from injury to definitive care is critically important for better outcome of trauma patients. However, there was no established evidence to support it. We aimed to validate the association between time to definitive care and mortality in hemodynamically unstable patients for the current trauma care settings.
Methods: The data were collected from the Japan Trauma Data Bank between 2006 and 2015. The inclusion criteria were patients with systolic blood pressure (SBP) <90 mm Hg and heart rate (HR) >110 beats/min or SBP <70 mm Hg who underwent definitive care within 4 hours from the onset of injury and survived for more than 4 hours. The outcome measure was in-hospital mortality. We evaluated the relationship between time to definitive care and mortality using the generalized additive model (GAM). Subgroup analysis was also conducted using GAM after dividing the patients into the severe (SBP <70 mm Hg) and moderate (SBP ≥70 mm Hg and <90 mm Hg, and HR >110 beats/min) shock group.
Results: 1169 patients were enrolled in this study. Of these, 386 (33.0%) died. Median time from injury to definitive care was 137 min. Only 61 patients (5.2%) received definitive care within 60 min. The GAM models demonstrated that mortality remained stable for the early phase, followed by a decrease over time. The severe shock group presented with a paradoxical decline of mortality with time, whereas the moderate shock group had a time-dependent increase in mortality.
Discussion: We did not observe the association of shorter time to definitive care with a decrease in mortality. However, this was likely an offset result of severe and moderate shock groups. The result indicated that early definitive care could have a positive impact on survival outcome of patients with moderate shock.
Level Of Evidence: Level Ⅳ, prognostic study.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066640 | PMC |
| http://dx.doi.org/10.1136/tsaco-2019-000405 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The Potential for High-Priority Care Based on Pain Through Facial Expression Detection with Patients Experiencing Chest Pain.
Diagnostics (Basel)
December 2024
Department of Computer Science, Tunghai University, Taichung 407224, Taiwan.
Background And Objective: Cardiovascular disease (CVD), one of the chronic non-communicable diseases (NCDs), is defined as a cardiac and vascular disorder that includes coronary heart disease, heart failure, peripheral arterial disease, cerebrovascular disease (stroke), congenital heart disease, rheumatic heart disease, and elevated blood pressure (hypertension). Having CVD increases the mortality rate. Emotional stress, an indirect indicator associated with CVD, can often manifest through facial expressions.
View Article and Find Full Text PDFThe Role of Medical Helicopter and Ground Medical Crews in Polytrauma Management: An Evaluative Perspective.
Patient Relat Outcome Meas
December 2024
Clinical-Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galati, Romania.
Introduction: Polytrauma remains a major global health challenge, with rapid intervention being critical for survival, especially during the "Golden Hour". This study examines the impact of Helicopter Emergency Medical Services (HEMS) on procedural care during the transfer of polytraumatized patients to urban hospitals in Romania.
Methods: A retrospective cohort study was conducted at the County Emergency Hospital "St.
Investigating emergency rescue readiness on Indian national highways: A case study of Jaipur-Jodhpur Highways (India) using a geospatial approach.
J Family Med Prim Care
November 2024
Central Bureau of Health Intelligence, Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India.
Background: Highways represent the most significant capital asset that any country's public sector holds. A system of national highways with easy access to ambulance and trauma centers is termed emergency rescue ready and helps reduce the mortality due to road accidents. Given the rich impetus for road infrastructure development by the government of India, there is a need to consider emergency rescue readiness on highways.
View Article and Find Full Text PDFGeo-Spatial Analysis of Acute Ischemic Stroke Reperfusion Treatment in India: An Assessment of Distribution and Access to Centers.
Int J Stroke
December 2024
PN Sylaja, DM, Professor and Head of Neurology, SCTIMST, Thiruvananthapuram, Kerala, India.
Background: Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited.
Aims: We evaluated the spatial distribution and geographic accessibility of stroke centers in India.
'Golden day' is a myth: rethinking medical timelines and risk in large scale combat operations.
BMJ Mil Health
November 2024
Surgeon General, Ministry of Defense, London, UK.
The evolving landscape of battlefield medicine forces medical planners to prepare for large-scale combat operations (LSCO) against peer adversaries, requiring reassessment of recent medical strategies. Despite lacking medical backing, the term 'golden day' has been used by senior military leaders to link the resuscitative benefits of the 'golden hour' to prolonged medical care through similar nomenclature. Pseudomedical terminology can easily enter the lexicon of commanders as attractive soundbites.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!