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Capstone

The Golden Hour Revisited

1 January 1999

Abstract

Abstract Background. It has been stated that the first 60 minutes following an accident often determines whether a patient will live or die. It is the objective of this study to determine if the Golden Hour theory is a valid concept that should continue to be applied to pre-hospital transport of the severely injured patient. Hypothesis: This study will test the null hypothesis that patient outcomes are independent of transport times. Methods: Data were obtained from a statewide trauma registry from the years 1993 to 1998 for this non-concurrent cohort study. The study sample consisted of2,621 patients 16 year of age or older with injury severity scores of greater than or equal to 25. Patients with transport times less than or equal to 60 minutes (n = 2121) were compared to patients with transport times greater than 60 minutes (n = 499). The primary dependent variable of this study was mortality. Results: The average mortality rate for severely injured patients transported in less than or equal to 60 minutes was higher than the average mortality rate for patients transported in greater than 60 minutes (36.2% versus 22.2%). Furthermore, patients with a penetrating mechanism of injury transported in less than or equal to 60 minutes encountered greater average mortality compared to similarly injured patients with transport times greater than 60 minutes (52.0% versus 36.1 %). Patients with transport times greater than 60 minutes exhibited higher morbidity as evidenced by longer stays in the hospital and intensive care unit. However, morbidity was not significantly different for patients with penetrating injuries transported in greater than 60 minutes versus patients transported in less than or equal to 60 minutes. Conclusions: It is apparent from this research that pre-hospital time defined in the terms of a Golden Hour does not significantly decrease mortality. Basing trauma system transport standards only on time is inappropriate.


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