RT Journal Article
SR Electronic
T1 The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 1141
OP 1152
DO 10.1503/cmaj.071154
VO 178
IS 9
A1 Ian G. Stiell, MD MSc
A1 Lisa P. Nesbitt, MHA
A1 William Pickett, PhD
A1 Douglas Munkley MD
A1 Daniel W. Spaite MD
A1 Jane Banek, CHIM
A1 Brian Field, MBA EMCA
A1 Lorraine Luinstra-Toohey, BScN MHA
A1 Justin Maloney MD
A1 Jon Dreyer MD
A1 Marion Lyver MD
A1 Tony Campeau, MAEd PhD
A1 George A. Wells, PhD
A1 for the OPALS Study Group
YR 2008
UL http://www.cmaj.ca/content/178/9/1141.abstract
AB 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.