Association between Scene Time Interval and Survival in EMS-Treated Major Trauma Admitted to the Intensive Care Unit: A Multinational, Multicenter Observational Study.

Objective: Major trauma is a major concern in public health and a leading cause of mortality worldwide. This study aimed to evaluate the association between the prehospital scene time interval (STI) and survival in emergency medical service (EMS)-assessed major trauma patients admitted to the intensive care unit (ICU). Methods: A retrospective observational study using the Pan-Asian Trauma Outcomes Study (PATOS) database was conducted. Adult trauma patients with injury severity scores (ISSs) greater than 15 who were admitted to the ICU were selected. EMS STIs were categorized into three groups: short (0-8 minutes), intermediate (9-16 minutes), and long (over 16 minutes). The primary outcome was survival to hospital discharge, and the secondary outcome was good neurological outcome at hospital discharge. Multivariable logistic regression analysis was conducted to calculate odds ratios and confidence intervals, adjusting for age, sex, mechanism of injury, prehospital alertness, prehospital shock index, response time interval, and EMS intervention (airway, oxygen supplementation, and intravenous fluid administration). Sensitivity analysis for patients who underwent surgery or nontraumatic brain injury cases and interaction analysis by EMS intervention were performed. Results: Data from a total of 1,874 eligible patients were analyzed. Intermediate and long STIs showed significant associations with outcomes, with adjusted ORs (95% CI) of 1.21 (1.07-1.38) in the intermediate STI group and 1.74 (1.55-1.96) in the long STI group for survival and 1.37 (1.32-1.40) in the intermediate STI group and 1.31 (1.22-1.41) in the long STI group for neurological outcome. In the sensitivity analysis, the highest ORs were found in the intermediate STI group, with adjusted ORs (95% CI) of 1.40 (1.37-1.42) for survival and 1.32 (1.26-1.38) for neurological outcome. In the interaction analysis, EMS intervention showed a positive interaction effect with an intermediate STI on survival. Conclusion: In EMS-assessed adult major trauma patients admitted to the ICU, we found significant associations between STIs longer than 8 minutes and outcomes. EMS intervention has a positive interaction effect with an intermediate STI on survival. More research is needed to understand the implications of practice for major trauma in the field.

The risk factors of acute coronary syndrome in patients over 65 years old at Thong Nhat Hospital of Ho Chi Minh City, Vietnam.

BACKGROUND: Elderly patient group is increasing quickly. The same phenomenon is seen in Vietnam. The prevalence of coronary artery disease(CAD) also increases with age. This was seen at Thong Nhat hospital, where was a high proportion of elderly patients admitted with acute coronary syndrome(ACS). This is why there was a need for studies on the risk factors and prevention of ACS for the elderly patients in Vietnam. OBJECTIVES: We assess the prevalence of common risk factors in the elderly patients with ACS admitted to Thong Nhat hospital. METHOD OF STUDY: A retrospective cross-sectional descriptive study was conducted at Thong Nhat hospital in Ho Chi Minh city from 1/2009 to 1/2011, in which 338 patients with ACS were divided in two groups: 214 patients over 65 years(62 females and 152 males) formed elderly group and 124 patients ≤ 65 years(21 females and 103 males) formed non-elderly group. The cardiovascular risk factors of ACS were hypertension(HT), diabetes mellitus(DM), smoking, dyslipidemia and obesity(BMI ≥ 23 kg/m(2)). A comparison of risk factors between the two group was done by Chi square. RESULTS: The number of female with was higher in the elderly group with ACS. Most of the elderly group had multiple risk factors. The percentage of 1, 2, 3 and 4 risk factor were 3.3; 32.2; 41.1% and 23.4%, respectively and they were similar to non-elderly group. In the elderly group, the prevalence of HT and DM were 84.6% and 29.0% higher than that in the non elderly group; the prevalence of smoking and dyslipidemia were 22.0% and 56.9% lower than that in the non-elderly group. The prevalence of the elderly patients with angina pectoris was 41.1% higher than that in the nonelderly group but the prevalence of non-typical angina was 42.1% higher than that in the non-elderly group(16.1%). The prevalence of prior myocardial infarction in elderly group was 18.2%, while the prevalence of obesity was 35.8% similar to that of the non-elderly group. CONCLUSION: In elderly patients with ACS, multiple risk factors were common. The prevalence of HTN and DM was higher, smoking and dyslipidemia were lower, being overweight and having a prior myocardial infarction was similar to that of the non-elderly group.