Comparative effectiveness of inhospital trauma resuscitation at a French trauma center and matched patients treated in the United States

Authors

Adil H. Haider, The Johns Hopkins School of Medicine, BaltimoreFollow
Jean-Stephane David, Lyon Sud Hospital, Hospices Civils de Lyon (HCL), Pierre Benite, France
Syed Nabeel Zafar, Howard University College of Medicine, Washington
Pierre-Yves Gueugniaud, Edouard Herriot Hospital (HCL), Lyon, France
David T. Efron, The Johns Hopkins School of Medicine, Baltimore
Bernard Floccard, Edouard Herriot Hospital (HCL), Lyon, France
Ellen J. MacKenzie, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
Eric Voiglio, Lyon Sud Hospital (HCL), Pierre Benite, France

Document Type

Article

Department

General Surgery

Abstract

Objective: The objective of this paper is to compare mortality outcomes between patients treated at a trauma center in France and matched patients in the United States.
Background: Although trauma systems in France and the United States differ significantly in prehospital and in hospital management, previous comparisons have been challenged by the lack of comparable data.
Methods: Coarsened exact matching identified matching patients between a single center trauma database from Lyon, France, and the National Trauma Data Bank (NTDB) of the United States. Moderate to severely injured [injury severity score (ISS) > 8] adult patients (age ≥ 16) presenting alive to level 1 trauma centers from 2002 to 2005 with blunt or penetrating injuries were included. After matching patients, multivariate regression analyses were performed to determine difference in mortality between patients in Lyon and the NTDB.
Results: A total of 1043 significantly injured patients were presented to the Lyon center. Matching eligible patients with complete records were sought from 219,985 patients in the NTDB. The unadjusted odds of mortality at the Lyon center was 2.5 times higher than that of the NTDB [95% confidence interval (CI) = 2.18-2.98]. However, the Lyon center received patients with higher ISS, lower Glasgow Coma Score (GCS), and lower systolic blood pressure (SBP) (all P < 0.001). After 1:1 matching, 858 patient pairs were produced, and the odds of mortality became equivalent [odds ratio (OR) = 1.3, 95% CI = 0.91-1.73]. Similar results were found in multiple subset analyses.
Conclusions: Trauma patients admitted to a single French trauma center had an equal chance of survival compared with similarly injured patients treated at US trauma centers.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Annals of surgery

Recommended Citation

Haider, A. H., David, J., Zafar, S. N., Gueugniaud, P., Efron, D. T., Floccard, B., MacKenzie, E. J., Voiglio, E. (2013). Comparative effectiveness of inhospital trauma resuscitation at a French trauma center and matched patients treated in the United States. Annals of surgery, 258(1), 178-183.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/248