Blunt-Trauma Outcomes Similar With Advanced, Basic Life Support

By Reuters Staff

February 04, 2020

NEW YORK (Reuters Health) - Advanced life support (ALS) does not improve outcomes in blunt trauma compared with basic life support (BLS), according to new findings.

"When accounting for injury severity, there is no advantage in mortality, complications or (length of hospital stay) between patients who received ALS versus BLS prehospital care," Dr. Michael S. Farrell of Christiana Care Health System in Newark, Delaware, and colleagues write in the American Journal of Surgery.

Previous studies have suggested that ALS is not better than BLS for patients with penetrating trauma, with some finding that ALS led to worse outcomes, Dr. Farrell and colleagues note.

The team looked at 698 patients treated at their Level-1 trauma center in July-December 2014, including 68% transported by ALS and 32% by BLS.

There were 23 deaths in the hospital. Mortality was 4.4% with ALS versus 0.9% with BLS (P=0.01). Thirty-four patients had complications, including 6.3% of the ALS patients and 1.8% of the BLS patients (P=0.009).

Adjusting for sex, race, age and pre-hospital time did not account for the differences in complications and mortality, but after accounting for Injury Severity Score (ISS) the risk difference was no longer statistically significant.

The authors also analyzed prehospital interventions and mortality in the ALS patients only, and found 95% underwent at least one intervention. Mortality rate was 0% with no interventions, 4.5% with one, 1% with two, and 32% with three or more (P<0.001).

The number of interventions was not associated with prehospital time.

Lower injury severity based on the ISS and the abbreviated injury scale were the only factors consistently related to better outcomes.

"While each trauma patient is unique and there are certainly instances in which patients may benefit from advanced emergency interventions, the specific emergencies and types of injuries that would benefit from ALS over BLS remain unclear," Dr. Farrell and colleagues write.

"With respect to both patient outcomes and resource utilization, this study continues to question the role of ALS in the blunt trauma population. Additional studies are needed to better elucidate those patients who may benefit from an ALS response," they add.

Dr. Farrell was not available for an interview by press time.

SOURCE: American Journal of Surgery, online January 21, 2020.