Pre-hospital times and clinical characteristics of severe trauma patients: A comparison between mountain and urban/suburban areas

Published:February 02, 2018DOI:



      We investigated pre-hospital times, clinical characteristics and therapeutic interventions in multisystem trauma patients injured in mountainous areas in comparison to both urban and suburban trauma patient admissions.


      Pre-hospital and in-hospital data collected from trauma patients included in the International Alpine Trauma Register (IATR) hosted in Bolzano, Italy (aged 16–80 yr with an ISS ≥ 16), were compared with trauma patient data published from those urban and suburban areas included in the Trauma Register DGU® (TR-DGU) of the German Trauma Society.


      A total of 94 patients from the IATR and 11,020 patients from the TR-DGU met the inclusion criteria. Due to longer treatment-free intervals (mean 59.1 vs. 19.7 min), total out-of-hospital time was reportedly longer in individuals injured in mountainous areas, compared to urban/suburban areas (117.4 ± 142.9 vs. 68.7 ± 28.6 min, p = 0.002), despite the more frequent helicopter rescue (93% vs. 40%, p < 0.001). 57% of IATR patients were hypothermic at hospital arrival, mean ISS was higher (38.5 ± 15.8 vs. 28.6 ± 12.2, p < 0.001) and patients with a systolic blood pressure (SBP) ≤90 mm Hg were more frequent (27% vs. 15%, p = 0.005), yet less patients had received volume therapy (82% vs. 93%, p = 0.001). However, overall no difference in hospital mortality was observed (11% vs. 17%, p = 0.159).


      Trauma incidents in mountainous areas commonly feature significantly increased out-of-hospital time which is associated with a more severe ISS, higher risk of accidental hypothermia and more frequent hypotension compared to urban/suburban trauma. Nonetheless, the mortality rate of IATR patients is comparable to urban/suburban trauma patients.


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        • Thole R.T.
        Preparation and medical management of events in mountain and high-altitude environments.
        Curr Sports Med Rep. 2004; 3: 128-133
        • Marsigny B.
        • Lecoq-Jammes F.
        • Cauchy E.
        Medical mountain rescue in the Mont-Blanc massif.
        Wilderness Environ Med. 1999; 10: 152-156
        • Gosteli G.
        • Yersin B.
        • Mabire C.
        • Pasquier M.
        • Albrecht R.
        • Carron P.N.
        Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports.
        Injury. 2016; 47: 1414-1420
        • Strapazzon G.
        • Costanzi E.
        • Bonsante F.
        • Rilk C.
        • Mair P.
        • Brugger H.
        International Alpine Trauma Registry: preliminary results for trauma life support in the mountains.
        Resuscitation. 2013; 84: S96-S97
        • Timm A.
        • Maegele M.
        • Lefering R.
        • Wendt K.
        • Wyen H.
        • TraumaRegister D.G.U.
        Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands.
        Injury. 2014; 45: S43-52
        • Dick W.F.
        • Baskett P.J.
        Recommendations for uniform reporting of data following major trauma—the Utstein style. A report of a working party of the International Trauma Anaesthesia and Critical Care Society (ITACCS).
        Resuscitation. 1999; 42: 81-100
        • TraumaRegister DGU
        20 years TraumaRegister DGU((R)): development, aims and structure.
        Injury. 2014; 45: S6-S13
        • R Development Core Team
        R: a language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2015
        • Kehoe A.
        • Smith J.E.
        • Edwards A.
        • Yates D.
        • Lecky F.
        The changing face of major trauma in the UK.
        Emerg Med J. 2015; 32: 911-915
        • Grossman M.D.
        • Ofurum U.
        • Stehly C.D.
        • Stoltzfus J.
        Long-term survival after major trauma in geriatric trauma patients: the glass is half full.
        J Trauma Acute Care Surg. 2012; 72: 1181-1185
        • Hearns S.
        The Scottish mountain rescue casualty study.
        Emerg Med J. 2003; 20: 281-284
        • Sampalis J.S.
        • Lavoie A.
        • Williams J.I.
        • Mulder D.S.
        • Kalina M.
        Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients.
        J Trauma. 1993; 34: 252-261
        • Baez A.A.
        • Lane P.L.
        • Sorondo B.
        • Giraldez E.M.
        Predictive effect of out-of-hospital time in outcomes of severely injured young adult and elderly patients.
        Prehosp Disaster Med. 2006; 21: 427-430
        • Cowley R.A.
        A total emergency medical system for the State of Maryland.
        Md State Med J. 1975; 24: 37-45
        • Messick W.J.
        • Rutledge R.
        • Meyer A.A.
        The association of advanced life support training and decreased per capita trauma death rates: an analysis of 12,417 trauma deaths.
        J Trauma. 1992; 33: 850-855
        • Smith R.M.
        • Conn A.K.
        Prehospital care - scoop and run or stay and play?.
        Injury. 2009; 40: S23-26
        • Pasquier M.
        • Geiser V.
        • De Riedmatten M.
        • Carron P.N.
        Helicopter rescue operations involving winching of an emergency physician.
        Injury. 2012; 43: 1377-1380
        • Soteras I.
        • Subirats E.
        • Strapazzon G.
        Epidemiological and medical aspects of canyoning rescue operations.
        Injury. 2015; 46: 585-589
        • Moppett I.K.
        Traumatic brain injury: assessment, resuscitation and early management.
        Br J Anaesth. 2007; 99: 18-31
        • Spahn D.R.
        • Bouillon B.
        • Cerny V.
        • Coats T.J.
        • Duranteau J.
        • Fernandez-Mondejar E.
        • et al.
        Management of bleeding and coagulopathy following major trauma: an updated European guideline.
        Crit Care. 2013; 17: R76
        • Beloncle F.
        • Meziani F.
        • Lerolle N.
        • Radermacher P.
        • Asfar P.
        Does vasopressor therapy have an indication in hemorrhagic shock?.
        Ann Intensive Care. 2013; 3: 13
        • Trentzsch H.
        • Huber-Wagner S.
        • Hildebrand F.
        • Kanz K.G.
        • Faist E.
        • Piltz S.
        • et al.
        Hypothermia for prediction of death in severely injured blunt trauma patients.
        Shock. 2012; 37: 131-139