Current support for severe blunt trauma patients in France: initial assessment of the FIRST study (French Intensive care Recorded in Severe Trauma)

Aim: The FIRST study (French Intensive care Recorded in Severe Trauma) was designed in order to describe the French management of severe blunt trauma in collaboration with 14 University hospitals. Procedure: Epidemiological, clinical data of pre- and in-hospital evolution were prospectively recorded for 3090 patients admitted in ICU within 72 hours after trauma and/or managed by a prehospital medical team of a participant center. Results: The mean age is 42 years old (SD 18), 61% of patients are road traffic victims, 30% are miscellaneous accidents victims (domestic, sports.) and 7% are involved in work accident and 2% in other type of accident. More than 50% of patients are intubated during prehospital care. Median Coma Glasgow Score is 12; IQR [6; 15]. After prehospital management, mean arterial pressure evolves from 89 mmHg (SD 29) to 84 mmHg (SD 23). Mean prehospital fluid loading is 788 +/- 862 ml and 16% of patients receive prehospital continuous catecholamine infusion. Nearly 25% of patients are initially admitted in a general hospital before University hospital transfer. Such strategy increases delay admission to University hospital (1,9 hours, IQR [1,3 - 2,5 hours] to 6,4 hours, IQR [5,0 - 8,4 hours], p < 0,001. Many patients were not managed by a medical prehospital team (7%) and whole-body CT on admission is not systematically performed. The injury severity score (median ISS: 25; IQR [18; 34]) may explain the time stay in intensive care unit (7 days), IQR [2 - 19 days] where 57% of patients have sepsis complications, and the global mortality of 23% at the 30th day. Conclusion: This study shows that all recommendations are well followed and promotes the installation of formalized regional care systems.