Association between prehospital time and trauma outcomes: A multicenter cohort study from the Pan-Asian Trauma Outcomes Study (PATOS).

BACKGROUND: Prehospital time is a critical determinant of trauma outcomes, yet its optimal duration remains unclear.

OBJECTIVES: To summarize the patterns of prehospital time across countries and determine the association between prehospital time and mortality in trauma patients.

METHODS: We conducted a cross-national, multicenter retrospective cohort study of trauma patients who received EMS care and were ground-transported to hospitals between January 2019 and December 2022 using the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time was categorized into response time (RT), on-scene time (OST), transport time (TT), and total prehospital time (TPT). Outcomes were in-hospital mortality and poor functional outcome. Multivariable logistic regression adjusted for confounders, with subgroup analysis by injury mechanism.

RESULTS: A total of 8968 patients from Taiwan, Malaysia, Korea, and Thailand were included; 376 (4.2%) died in hospital. Mean RT, OST, TT, and TPT were 16.2, 9.6, 9.9, and 35.7 min, respectively. Longer RT (adjusted odds ratio [aOR] 1.03, 95% CI 1.01-1.04) and OST (aOR 1.03, 95% CI 1.02-1.05) were independently associated with increased in-hospital mortality, whereas TT was not. Prolonged OST and TT were associated with poor functional outcomes. Among patients with traffic-related injuries, longer RT and OST remained significantly associated with mortality.

CONCLUSION: Prehospital time varies across EMS systems. Prolonged RT and OST were associated with increased mortality, while extended OST and TT were associated with poor functional outcomes. However, these associations may reflect more severely ill patients requiring additional care.