• Jean-Michel Yeguiayan, Delphine Garrigue, Christine Binquet, Claude Jacquot, Jacques Duranteau, Claude Martin, Fatima Rayeh, Bruno Riou, Claire Bonithon-Kopp, Marc Freysz, and French Intensive Care Recorded In Severe Trauma Study Group.
• Université de Bourgogne, Service d'Anesthésie et Réanimation - SAMU 21, Hôpital Général, 3 Rue Faubourg Raines, Centre Hospitalier Universitaire de Dijon, Faculté de médecine, 21033 Dijon Cedex, France. yeguiayan.jeanmichel@neuf.fr
• Crit Care. 2011 Jan 1;15(1):R34.

IntroductionSevere blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality.ResultsAmong 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results.ConclusionsThis study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.

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