The Meaning of 'Golden Hour' in Prehospital Time for Abdominal Trauma Victims with Emergency Laparotomy

Jang, Tae Chang; Lee, Kyung Won

Abstract

PURPOSE
The "golden hour" concept in trauma is pervasive despite little evidence to support it. This study addressed the association between prehospital time and in-hospital mortality in seriously injured abdominal trauma victims.
METHODS
A retrospective study was conducted over a three-year period from 2006 to 2008. We analyzed trauma victims with abdominal injuries who underwent an emergency laparotomy in a local emergency center located in a city with a population of 2,500,000. According to the 'golden hour' concept, we separated the trauma victims into two groups (Gourp 1: prehospital time < or = 1 hour, Group 2: prehospital time > 1hour) and investigated several factors, such as time, process, and outcome.
RESULTS
During the period from January 2006 to December 2008 139 trauma victims underwent an emergency laparotomy, and 89 of them were enrolled in this study. Between the two groups, emergency department (ED) access, transportation, and injury mechanism showed statistically meaningful differences, but no statistically meaningful differences were observed in various measures of the outcome, such as length of hospital stay, length of Intensive Care Unit stay, and mortality. In a univariate logistic regression study, age (odds ratio [OR]: 1.101; 95% confidence interval [CI]: 1.026 to 1.182), Revised Trauma Score (RTS) (OR: 0.444; 95% CI 0.278 to 0.710), hemoglobin (OR: 0.749; 95% CI: 0.585 to 0.960), and creatinine (OR: 24.584; 95% CI: 2.019 to 299.364) were significant prognostic factors, but prehospital time was not. In a multivariate logistic regression study, age and RTS were significant associated with mortality.
CONCLUSION
In this study, we found no association between prehospital time and mortality among abdominal trauma patient who underwent an emergency laparotomy. We suggest that in our current out-of-hospital and emergency care system, until arrival at the hospital time may be less crucial for trauma victims than once thought.