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referral from the scene, with little or no resuscitation initiated, or IHT, with prior stabilisation), there was a significantly lower baseline lactate level in the paediatric group.
Although patient risk can be reduced with increased staffing, careful planning, and use of appropriate equipment, unexpected complications remain common during IHT; when they do occur, they may be difficult to treat (Lahner et al., 2005; Warren, Fromm, Orr, Rotello, & Horst, 2004).
First, point-of-care technology, unlike IHT, means that the patient remains in their bed and care is not interrupted.
Entry and exit criteria were defined according to published recommendations.2 Admissions are derived direct from scene (DIR) in consultation with the pre-hospital care providers, or by interhospital transfer (IHT).
We compared patients admitted DIR and IHT with respect to mechanism and severity of injury, time to reach definitive care (which was defined as ICU admission), and outcome.
The significant difference in overall mean ISS between the DIR and IHT groups was accounted for by the significantly higher ISS in those who died.
No significant association was found with injury mechanism and there was no significant difference in overall mortality rate between the DIR and IHT groups.
Excluding early deaths during resuscitation or in theatre, which are not represented in the IHT group, for equally severe injuries as graded by the ISS, survival is significantly improved by direct transfer to a level I trauma unit.
In 1997 the ICU mortality rate in a local regional hospital without a dedicated trauma service was 28.3%, (15) little different from that in the IHT group in our cohort.
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