Factors Associated with Prolonged Prehospital On-Site Time in Adult Trauma Patients: A Nationwide Observational Study in Japan.

Abstract

Introduction: Time elapsed since trauma onset is a critical determinant of prognosis in trauma patients. However, factors behind prolonged prehospital on-site time remain unclear. This study aimed to identify associated factors in trauma cases.

Methods: Using a nationwide Japanese database, adults who experienced trauma and were treated between January 2004 and May 2019 were identified. Multivariable logistic regression with multiple imputations for missing data was performed to compare characteristics of patients with shorter and longer prehospital on-site times.

Results: Data from 150,215 patients were included. Multivariable logistic regression with multiple imputations for missing data revealed that longer prehospital on-site time was associated with younger age, male sex (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11-1.16), weekends and holidays (OR, 1.06; 95% CI, 1.03-1.08), alcohol consumption (OR, 1.31; 95% CI, 1.26-1.36), fall (OR, 1.07; 95% CI, 1.05-1.10), other blunt trauma (OR, 1.12; 95% CI, 1.07-1.18), suicide (OR, 1.20; 95% CI, 1.13-1.27), violence (OR, 1.33; 95% CI, 1.20-1.46), hypotension (OR, 1.15; 95% CI, 1.09-1.22), higher Revised Trauma Score (OR, 1.21; 95% CI, 1.20-1.23), Abbreviated Injury Scale (AIS) category 6 (spine) ≥ 3 (OR, 1.21; 95% CI, 1.17-1.25), AIS category 7 (upper extremities) ≥ 3 (OR, 1.15; 95% CI, 1.10-1.21), immobilization (OR, 1.25; 95% CI, 1.22-1.28), intravenous line placement (OR, 1.27; 95% CI, 1.17-1.37), intubation (OR, 1.44; 95% CI, 1.26-1.64), mental disease (OR, 1.07; 95% CI, 1.02-1.13), chronic kidney disease undergoing hemodialysis (OR, 1.12; 95% CI, 1.03-1.22), and malignancy (OR, 1.11; 95% CI, 1.04-1.18).

Conclusions: Several factors associated with prolonged prehospital on-site time were identified. Interventions targeting these factors may help shorten prehospital on-site time.