Prehospital advanced versus basic life support: A cohort study comparing survival to hospital for major trauma patients in New Zealand.

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care Pub Date : 2025-10-11 DOI:10.1016/j.auec.2025.09.008

Nicola Campbell, Rebbecca Lilley, Gabrielle Davie, Kate Morgaine, Bridget Dicker, Bridget Kool

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引用次数: 0

Abstract

Objective: To examine the relationship between prehospital Advanced Life Support (ALS) and survival to hospital for major trauma patients in New Zealand and explore its implications for Emergency Medical Service (EMS) practice.

Methods: A mixed-methods explanatory design was used. Data on major trauma patients attended by road EMS (December 2016-November 2018) was analysed. A multivariable model with propensity scores estimated the odds of survival for patients receiving Advanced versus Basic Life Support (BLS). Semi-structured interviews conducted with EMS stakeholders were analysed using thematic analysis.

Results: Among 1118 patients, 661 (59 %) received ALS. Only 52 (5 %) did not survive to hospital. Multivariable modeling estimated ALS recipients had 1.5 times higher odds of survival than BLS-only recipients (OR 1.49, 95 % CI 0.66-3.35). Interviews with five EMS clinical leaders highlighted two likely influences: clinical judgment and evidence use. Despite imprecise quantitative findings, stakeholders supported ALS based on clinical judgment.

Conclusions: A tension between population-level results and provision of care based on clinical judgement exists. Quantitative analysis found no evidence that ALS offers a survival benefit, although considerable uncertainty exists, whereas stakeholders perceive ALS has clinical and equity benefits. Future research should assess equity, disability, and quality of life outcomes of ALS.

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院前高级生命支持与基本生命支持：一项比较新西兰重大创伤患者住院生存率的队列研究。

目的：探讨新西兰严重创伤患者院前高级生命支持（ALS）与住院生存率的关系，并探讨其对急诊医疗服务（EMS）实践的启示。方法：采用混合方法解释设计。分析2016年12月至2018年11月道路EMS治疗的重大创伤患者数据。一个带有倾向评分的多变量模型估计了接受高级生命支持与基本生命支持（BLS）的患者的生存几率。对EMS利益相关者进行的半结构化访谈使用主题分析进行了分析。结果：1118例患者中，661例（59 %）接受ALS治疗。只有52例（5 %）未存活至医院。多变量模型估计ALS接受者的生存几率比仅bls接受者高1.5倍（OR 1.49, 95 % CI 0.66-3.35）。与五位EMS临床领导者的访谈强调了两个可能的影响：临床判断和证据使用。尽管定量结果不精确，但利益相关者基于临床判断支持ALS。结论：人群水平的结果和基于临床判断的护理提供之间存在紧张关系。定量分析发现，尽管存在相当大的不确定性，但没有证据表明ALS提供生存益处，而利益相关者认为ALS具有临床和公平益处。未来的研究应评估ALS的公平性、致残性和生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australasian Emergency Care Nursing-Emergency Nursing

CiteScore

3.30

自引率

5.60%

发文量

审稿时长

37 days

期刊介绍： Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.