Definitive management of near‐hanging at major versus non‐major trauma centres

Abstract

AbstractObjectivesThe Victorian State Trauma System recommends that all major trauma patients receive definitive care at a major trauma service (MTS). The aim of the present study was to assess the outcomes of patients with major trauma after near‐hangings who received definitive management at an MTS compared to a non‐MTS.MethodsThis was a registry‐based cohort study of all adult (age ≥16 years) patients with near‐hanging included in the Victorian State Trauma Registry from 1 July 2010 to 30 June 2019. Outcomes of interest were death at hospital discharge, time to death and extended Glasgow Outcome Scale (GOSE) score of 5–8 (favourable) at 6 months.ResultsThere were 243 patients included and 134 (55.1%) in‐hospital deaths. Among patients presenting to a non‐MTS, 24 (16.8%) were transferred to an MTS. There were 59 (47.6%) deaths at an MTS and 75 (63.0%) at a non‐MTS (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.32–0.89). However, more patients were managed at a non‐MTS after out‐of‐hospital cardiac arrest (58.8% vs 50.8%) and less patients had serious neck injury (0.8% vs 11.3%). After adjustment for out‐of‐hospital cardiac arrests and serious neck injury, management at an MTS was not associated with mortality (adjusted OR [aOR] 0.61; 95% CI 0.23–1.65) or favourable GOSE at 6 months (aOR 1.09; 95% CI 0.40–3.03).ConclusionsAfter major trauma sustained from near‐hanging, definitive management at an MTS did not offer a mortality benefit or better functional outcomes. Consistent with current practice, these findings suggest that most near‐hanging related major trauma patients could be managed safely at a non‐MTS.