Revisiting the "golden hour"

An evaluation of out-of-hospital time in shock and traumatic brain injury

Craig Newgard, Eric N. Meier, Eileen M. Bulger, Jason Buick, Kellie Sheehan, Steve Lin, Joseph P. Minei, Roxy A. Barnes-Mackey, Karen Brasel

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Study objective We evaluate patients with shock and traumatic brain injury who were previously enrolled in an out-of-hospital clinical trial to test the association between out-of-hospital time and outcome. Methods This was a secondary analysis of patients with shock and traumatic brain injury who were aged 15 years or older and enrolled in a Resuscitation Outcomes Consortium out-of-hospital clinical trial by 81 emergency medical services agencies transporting to 46 Level I and II trauma centers in 11 sites (May 2006 through May 2009). Inclusion criteria were systolic blood pressure less than or equal to 70 mm Hg or systolic blood pressure 71 to 90 mm Hg with pulse rate greater than or equal to 108 beats/min (shock cohort) and Glasgow Coma Scale score less than or equal to 8 (traumatic brain injury cohort); patients meeting both criteria were placed in the shock cohort. Primary outcomes were 28-day mortality (shock cohort) and 6-month Glasgow Outcome Scale-Extended score less than or equal to 4 (traumatic brain injury cohort). Results There were 778 patients in the shock cohort (26% 28-day mortality) and 1,239 patients in the traumatic brain injury cohort (53% 6-month Glasgow Outcome Scale-Extended score ≤4). Out-of-hospital time greater than 60 minutes was not associated with worse outcomes after accounting for important confounders in the shock cohort (adjusted odds ratio [aOR] 1.42; 95% confidence interval [CI] 0.77 to 2.62) or traumatic brain injury cohort (aOR 0.77; 95% CI 0.51 to 1.15). However, shock patients requiring early critical hospital resources and arriving after 60 minutes had higher 28-day mortality (aOR 2.37; 95% CI 1.05 to 5.37); this finding was not observed among a similar traumatic brain injury subgroup. Conclusion Among out-of-hospital trauma patients meeting physiologic criteria for shock and traumatic brain injury, there was no association between time and outcome. However, the subgroup of shock patients requiring early critical resources and arriving after 60 minutes had higher mortality.

Original languageEnglish (US)
Pages (from-to)30-41.e3
JournalAnnals of Emergency Medicine
Volume66
Issue number1
DOIs
StatePublished - Jul 1 2015

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Shock
Blood Pressure
Glasgow Outcome Scale
Mortality
Odds Ratio
Confidence Intervals
Traumatic Brain Injury
Clinical Trials
Glasgow Coma Scale
Trauma Centers
Emergency Medical Services
Resuscitation
Heart Rate
Wounds and Injuries

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Revisiting the "golden hour" : An evaluation of out-of-hospital time in shock and traumatic brain injury. / Newgard, Craig; Meier, Eric N.; Bulger, Eileen M.; Buick, Jason; Sheehan, Kellie; Lin, Steve; Minei, Joseph P.; Barnes-Mackey, Roxy A.; Brasel, Karen.

In: Annals of Emergency Medicine, Vol. 66, No. 1, 01.07.2015, p. 30-41.e3.

Research output: Contribution to journalArticle

Newgard, Craig ; Meier, Eric N. ; Bulger, Eileen M. ; Buick, Jason ; Sheehan, Kellie ; Lin, Steve ; Minei, Joseph P. ; Barnes-Mackey, Roxy A. ; Brasel, Karen. / Revisiting the "golden hour" : An evaluation of out-of-hospital time in shock and traumatic brain injury. In: Annals of Emergency Medicine. 2015 ; Vol. 66, No. 1. pp. 30-41.e3.
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abstract = "Study objective We evaluate patients with shock and traumatic brain injury who were previously enrolled in an out-of-hospital clinical trial to test the association between out-of-hospital time and outcome. Methods This was a secondary analysis of patients with shock and traumatic brain injury who were aged 15 years or older and enrolled in a Resuscitation Outcomes Consortium out-of-hospital clinical trial by 81 emergency medical services agencies transporting to 46 Level I and II trauma centers in 11 sites (May 2006 through May 2009). Inclusion criteria were systolic blood pressure less than or equal to 70 mm Hg or systolic blood pressure 71 to 90 mm Hg with pulse rate greater than or equal to 108 beats/min (shock cohort) and Glasgow Coma Scale score less than or equal to 8 (traumatic brain injury cohort); patients meeting both criteria were placed in the shock cohort. Primary outcomes were 28-day mortality (shock cohort) and 6-month Glasgow Outcome Scale-Extended score less than or equal to 4 (traumatic brain injury cohort). Results There were 778 patients in the shock cohort (26{\%} 28-day mortality) and 1,239 patients in the traumatic brain injury cohort (53{\%} 6-month Glasgow Outcome Scale-Extended score ≤4). Out-of-hospital time greater than 60 minutes was not associated with worse outcomes after accounting for important confounders in the shock cohort (adjusted odds ratio [aOR] 1.42; 95{\%} confidence interval [CI] 0.77 to 2.62) or traumatic brain injury cohort (aOR 0.77; 95{\%} CI 0.51 to 1.15). However, shock patients requiring early critical hospital resources and arriving after 60 minutes had higher 28-day mortality (aOR 2.37; 95{\%} CI 1.05 to 5.37); this finding was not observed among a similar traumatic brain injury subgroup. Conclusion Among out-of-hospital trauma patients meeting physiologic criteria for shock and traumatic brain injury, there was no association between time and outcome. However, the subgroup of shock patients requiring early critical resources and arriving after 60 minutes had higher mortality.",
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