Traditional dogma teaches that it is crucial for trauma patients to reach the hospital and be treated within 1 hour of injury (the “golden hour”). Investigators reviewed data from a large trauma registry to determine outcomes for two cohorts of patients: 778 with traumatic shock and 1239 with traumatic brain injury.
In the traumatic-shock cohort, 26% died within 28 days of injury (the primary endpoint). In the brain-injury cohort, 53% experienced a bad outcome, defined as a 6-month Glasgow Outcome Scale–Extended score of ≤4 (the primary endpoint). Out-of-hospital time longer than 1 hour versus shorter than 1 hour was not associated with worse outcomes. Among 484 traumatic-shock patients requiring early critical hospital resources, those arriving after 1 hour had higher 28-day mortality than those arriving within 1 hour (adjusted odds ratio, 2.4).
COMMENT
This study from a large trauma registry demonstrated that patients with traumatic brain injury (TBI) but no shock had similar outcomes whether they arrived within one hour or after one hour of injury. However, patients who had traumatic shock had a lower 28-day mortality if they arrived within one hour versus arrival after one hour.
What is more critical for trauma patients who are NOT in shock is to get them to a Trauma Center as quickly as possible.
