CMAJ • April 22, 2008; 178 (9). doi:10.1503/cmaj.071154.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Résumé
Right arrow Online Appendix
Right arrow Videos
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Stiell, I. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Stiell, I. G., MD MSc
Related Collections
Right arrow Resuscitation
Right arrowRelated Articles

Research

The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity

Ian G. Stiell, MD MSc, Lisa P. Nesbitt, MHA, William Pickett, PhD, Douglas Munkley, MD, Daniel W. Spaite, MD, Jane Banek, CHIM, Brian Field, MBA EMCA, Lorraine Luinstra-Toohey, BScN MHA, Justin Maloney, MD, Jon Dreyer, MD, Marion Lyver, MD, Tony Campeau, MAEd PhD, George A. Wells, PhD for the OPALS Study Group

From the Departments of Emergency Medicine (Stiell) and of Epidemiology and Community Medicine (Wells), University of Ottawa, Ottawa, Ont.; the Clinical Epidemiology Program, Ottawa Health Research Institute (Stiell, Nesbitt, Banek, Wells), Ottawa, Ont.; the Department of Emergency Medicine (Pickett), Queen's University, Kingston, Ont.; Greater Niagara Base Hospital (Munkley, Luinstra-Toohey), Niagara Falls, Ont.; the Department of Emergency Medicine (Spaite), University of Arizona, Tucson, Ariz.; Interdev Technologies (Field), Toronto, Ont.; Ottawa Base Hospital Program (Maloney), Ottawa, Ont.; the Division of Emergency Medicine (Dreyer), University of Western Ontario, London, Ont.; the Department of Family Medicine (Lyver), McMaster University, Hamilton, Ont.; and Emergency Health Services (Campeau), Ontario Ministry of Health and Long-Term Care, Toronto, Ont.

Correspondence to: Dr. Ian G. Stiell, Clinical Epidemiology Unit, Rm. F657, Ottawa Health Research Institute, The Ottawa Hospital — Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; fax 613 761-5351; istiell{at}ohri.ca

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.


Related Articles

Highlights of this issue
Can. Med. Assoc. J. 2008 178: 1109. [Full Text] [PDF]

Dans ce numéro
Can. Med. Assoc. J. 2008 178: 1109. [Full Text] [PDF]

Should invasive airway management be done in the field?
Daniel P. Davis, MD
Can. Med. Assoc. J. 2008 178: 1171-1173. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Am. J. Respir. Crit. Care Med.Home page
R. A. Fowler, N. K. J. Adhikari, D. C. Scales, W. L. Lee, and G. D. Rubenfeld
Update in Critical Care 2008
Am. J. Respir. Crit. Care Med., May 1, 2009; 179(9): 743 - 758.
[Full Text] [PDF]

Home page
 CMAJHome page
I. M. Wishart MD
Prehospital and in-hospital advanced life-support
Can. Med. Assoc. J., July 1, 2008; 179(1): 56 - 56.
[Full Text] [PDF]

Home page
 CMAJHome page
D. P. Davis MD
Should invasive airway management be done in the field?
Can. Med. Assoc. J., April 22, 2008; 178(9): 1171 - 1173.
[Full Text] [PDF]

eLetters:

Read all eLetters

Pre hospital vs inhospital advanced life support
ian M wishart
CMAJ, 8 May 2008 [Full text]
Does the front door make a difference?
Dilip J DaCruz
CMAJ, 23 May 2008 [Full text]