Pre-hospital times and clinical characteristics of severe trauma patients: A comparison between mountain and urban/suburban areas

Abstract

Objective: We investigated pre-hospital times, clinical characteristics and therapeutic interventions in multisystem trauma patients injured in mountainous areas in comparison to both urban and suburban trauma patient admissions. Methods: Pre-hospital and in-hospital data collected from trauma patients included in the International Alpine Trauma Register (IATR) hosted in Bolzano, Italy (aged 16–80 yr with an ISS ≥ 16), were compared with trauma patient data published from those urban and suburban areas included in the Trauma Register DGU® (TR-DGU) of the German Trauma Society. Results: A total of 94 patients from the IATR and 11,020 patients from the TR-DGU met the inclusion criteria. Due to longer treatment-free intervals (mean 59.1 vs. 19.7 min), total out-of-hospital time was reportedly longer in individuals injured in mountainous areas, compared to urban/suburban areas (117.4 ± 142.9 vs. 68.7 ± 28.6 min, p = 0.002), despite the more frequent helicopter rescue (93% vs. 40%, p < 0.001). 57% of IATR patients were hypothermic at hospital arrival, mean ISS was higher (38.5 ± 15.8 vs. 28.6 ± 12.2, p < 0.001) and patients with a systolic blood pressure (SBP) ≤90 mm Hg were more frequent (27% vs. 15%, p = 0.005), yet less patients had received volume therapy (82% vs. 93%, p = 0.001). However, overall no difference in hospital mortality was observed (11% vs. 17%, p = 0.159). Conclusion: Trauma incidents in mountainous areas commonly feature significantly increased out-of-hospital time which is associated with a more severe ISS, higher risk of accidental hypothermia and more frequent hypotension compared to urban/suburban trauma. Nonetheless, the mortality rate of IATR patients is comparable to urban/suburban trauma patients.