The OPALS Major Trauma Study: Impact of advanced life-support on survival and morbidity

Ian G. Stiell, Lisa P. Nesbitt, William Pickett, Douglas Munkley, Daniel W. Spaite, Jane Banek, Brian Field, Lorraine Luinstra-Toohey, Justin Maloney, Jon Dreyer, Marion Lyver, Tony Campeau, George A. Wells

Research output: Contribution to journalArticle

173 Scopus citations

Abstract

Background: To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established Methods: The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. Results: Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8° among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16). Interpretation: The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.

Original languageEnglish (US)
Pages (from-to)1141-1152
Number of pages12
JournalCMAJ
Volume178
Issue number9
DOIs
StatePublished - Apr 22 2008

ASJC Scopus subject areas

  • Medicine(all)

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    Stiell, I. G., Nesbitt, L. P., Pickett, W., Munkley, D., Spaite, D. W., Banek, J., Field, B., Luinstra-Toohey, L., Maloney, J., Dreyer, J., Lyver, M., Campeau, T., & Wells, G. A. (2008). The OPALS Major Trauma Study: Impact of advanced life-support on survival and morbidity. CMAJ, 178(9), 1141-1152. https://doi.org/10.1503/cmaj.071154