Medical pre-hospital management reduces mortality in severe XXXX : a prospective epidemiological study.

@entity1 @entity204 @entity130
INTRODUCTION: Severe @entity130 is a leading cause of @entity204 and handicap. However, the benefit for the @entity1 of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de R  animation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. METHODS: The FIRST (French Intensive care Recorded in Severe @entity130 ) study is a multicenter cohort study on consecutive @entity1 with severe @entity130 requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. RESULTS: Among 2,703 @entity1 , 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR @entity1 presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR @entity1 . The crude 30-day mortality rate was comparable for SMUR and non-SMUR @entity1 (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. CONCLUSIONS: This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.
