Association of Prehospital Time with Traffic Injury Severity – Experiences From a Level-I Trauma Centre in Taiwan

Introduction: Research has reported that prehospital time and distance play a crucial role in determining patient outcomes such as mortality or injury severity. This study aimed to investigate the association of prehospital time with traffic injury severity. Methods: This study employed a retrospective analysis of data from January 1, 2016, to December 31, 2022, focusing on 5,022 traffic crash patients admitted to a Level-I trauma center and transported by EMS in Taiwan. The variables included were EMS prehospital time (response, on-scene, and transport times), patient demographics (age and gender), crash time, and injury severity score (ISS). Patients with ISSs ≥ 9 were classified as sustaining killed or serious injuries (KSIs). Chi-square tests identified risk factors, and logistic regression models estimated the adjusted odds ratio for KSI. Results: The results revealed that an increased minute of prehospital time was associated with an increase in the risk of KSI by 2%. A response time over 4 minutes raised the KSI risk by 80%, while on-scene and transport times of 7 minutes or more increased the risk by 98% and 87%, respectively. Total prehospital time exceeding 21 minutes led to a 97% higher KSI risk. Logistic regression models revealed that crashes between 00:00 and 5:00 had a 70% higher KSI risk, with elderly individuals at midnight facing a fivefold greater risk than other age groups. Conclusion: Study findings support the notion that enhancing EMS efficiency may provide crucial clues for improving trauma care programs. In addition, strategic deployment of emergency personnel during high-risk early morning hours can be beneficial in dealing with serious traffic accident injuries.