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                <title xml:lang="en">Association of Prehospital Time to In-Hospital Trauma Mortality in a Physician-Staffed Emergency Medicine System</title>
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              <p>IMPORTANCE The association between total prehospital time and mortality inphysician-staffed trauma systems remains uncertain.OBJECTIVE To describe the association of total prehospital time and in-hospital mortality inprehospital, physician-staffed trauma systems in France, with the hypothesis that totalprehospital time is associated with increased mortality.DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from January 2009to December 2016. Data for this study were derived from 2 distinct regional trauma registriesin France (1 urban and 1 rural) that both have a physician-staffed emergency medical service.Consecutive adult trauma patients admitted to either of the regional trauma referral centersduring the study period were included. Data analysis took place from March 2018 toSeptember 2018.MAIN OUTCOMES AND MEASURES The association between death and prehospital time wasassessed with a multivariable model adjusted with confounders. Total prehospital time wasthe primary exposure variable, recorded as the time from the arrival of the physician-ledprehospital care team on scene to the arrival at the hospital. The main outcome of interestwas all-cause in-hospital mortality.RESULTS A total of 10 216 patients were included (mean [SD] age, 41 [18] years; 7937 men[78.3%]) affected by predominantly nonpenetrating injuries (9265 [91.5%]), with a mean(SD) Injury Severity Score of 17 (14) points. Of the patients, 6737 (66.5%) had at least 1 bodyregion with an Abbreviated Injury Scale score of 3 or more. A total of 1259 patients (12.4%)presented in shock (with systolic pressure &lt;90 mm Hg) and 2724 (26.9%) with severe headinjury (Abbreviated Injury Scale score 3 points). On unadjusted analysis, increasingprehospital times (in 30-minute categories) were associated with a markedly and constantincrease in the risk of in-hospital death. The odds of death increased by 9% for each10-minute increase in prehospital time (odds ratio, 1.09 [95% CI, 1.07-1.11]) and afteradjustment by 4% (odds ratio, 1.04 [95% CI, 1.01-1.07]).CONCLUSIONS AND RELEVANCE In this study, an increase in total prehospital time wasassociated with increasing in-hospital all-cause mortality in trauma patients at aphysician-staffed emergency medical system, after adjustment for case complexity.Prehospital time is a management objective in analogy to physiological targets. Thesefindings plead for a further streamlining of prehospital trauma care and the need to definethe optimal intervention-to-time ratio.</p>
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