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

166 Citations (Scopus)

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
JournalCanadian Medical Association Journal
Volume178
Issue number9
DOIs
StatePublished - Apr 22 2008

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Advanced Trauma Life Support Care
Ontario
Morbidity
Survival
Glasgow Coma Scale
Wounds and Injuries
Mortality
Allied Health Personnel
Nonpenetrating Wounds
Injury Severity Score
Intratracheal Intubation
Controlled Clinical Trials
Emergency Medical Services

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stiell, I. G., Nesbitt, L. P., Pickett, W., Munkley, D., Spaite, D. W., Banek, J., ... Wells, G. A. (2008). The OPALS Major Trauma Study: Impact of advanced life-support on survival and morbidity. Canadian Medical Association Journal, 178(9), 1141-1152. https://doi.org/10.1503/cmaj.071154

The OPALS Major Trauma Study : Impact of advanced life-support on survival and morbidity. / Stiell, Ian G.; Nesbitt, Lisa P.; Pickett, William; Munkley, Douglas; Spaite, Daniel W; Banek, Jane; Field, Brian; Luinstra-Toohey, Lorraine; Maloney, Justin; Dreyer, Jon; Lyver, Marion; Campeau, Tony; Wells, George A.

In: Canadian Medical Association Journal, Vol. 178, No. 9, 22.04.2008, p. 1141-1152.

Research output: Contribution to journalArticle

Stiell, IG, Nesbitt, LP, Pickett, W, Munkley, D, Spaite, DW, Banek, J, Field, B, Luinstra-Toohey, L, Maloney, J, Dreyer, J, Lyver, M, Campeau, T & Wells, GA 2008, 'The OPALS Major Trauma Study: Impact of advanced life-support on survival and morbidity', Canadian Medical Association Journal, vol. 178, no. 9, pp. 1141-1152. https://doi.org/10.1503/cmaj.071154
Stiell, Ian G. ; Nesbitt, Lisa P. ; Pickett, William ; Munkley, Douglas ; Spaite, Daniel W ; Banek, Jane ; Field, Brian ; Luinstra-Toohey, Lorraine ; Maloney, Justin ; Dreyer, Jon ; Lyver, Marion ; Campeau, Tony ; Wells, George A. / The OPALS Major Trauma Study : Impact of advanced life-support on survival and morbidity. In: Canadian Medical Association Journal. 2008 ; Vol. 178, No. 9. pp. 1141-1152.
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