RT Journal Article
SR Electronic
T1 The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 1141
OP 1152
DO 10.1503/cmaj.071154
VO 178
IS 9
A1 Stiell, Ian G.
A1 Nesbitt, Lisa P.
A1 Pickett, William
A1 Munkley, Douglas
A1 Spaite, Daniel W.
A1 Banek, Jane
A1 Field, Brian
A1 Luinstra-Toohey, Lorraine
A1 Maloney, Justin
A1 Dreyer, Jon
A1 Lyver, Marion
A1 Campeau, Tony
A1 Wells, George A.
A1 ,
YR 2008
UL http://www.cmaj.ca/content/178/9/1141.abstract
AB Background: To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established Methods: The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before–after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results: Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9–1.7; p = 0.16). Interpretation: The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.