Available Data

This dataset only includes traumatic injury patients. For ROC cardiac arrest Epistry data please see: ROC-Cardiac Epistry 1 and 2 and ROC-Cardiac Epistry 3

Objectives

To build a prospective population-based registry of patients with out-of-hospital traumatic injury responded to by Emergency Medical Services (EMS). Specific aims included: to establish whether the results of Resuscitation Outcomes Consortium (ROC) trials can be generalized to the larger population of patients that experience traumatic injury; to more fully establish the burden of traumatic injury; and to examine the relationships between variation in EMS structure and process, regional and periodic factors, and patient outcomes.

Background

Traumatic injury is a major public health problem generating substantial morbidity, mortality, and economic burden on society. The majority of seriously injured persons are initially evaluated and cared for by prehospital providers, however the effect of EMS systems, EMS clinical care, and EMS interventions on trauma patient outcomes is largely unknown. EMS factors such as service level, number of responding providers, use of procedures or drugs in the field, training, quality assurance/feedback, and response time intervals also vary significantly by region.

The Resuscitation Outcomes Consortium (ROC) was established in 2004 to conduct clinical research in the areas of cardiopulmonary arrest and life-threatening traumatic injury with the overall goal of improving resuscitation outcomes. Previous trauma registries have generally focused primarily on hospitalized patients with limited prehospital information. Registries may also exclude trauma cases at far ends of the spectrum, such as those who die in the field or in a non-trauma center and/or patients that are treated and released. These limitations do not allow for detailed, outcome-based assessments of EMS system factors necessary to define prehospital resuscitation best practices. Therefore there was a need for standardized data collection of out-of-hospital traumatic injuries matched to hospital-based outcomes in diverse geographic locations in order to identify the independent effects of prognostic or treatment factors accounting for variations in survival.

Participants

All individuals (regardless of age) in the ROC regions that experienced traumatic injury outside of a hospital, met certain physiologic criteria, and were attended to by EMS were included in the registry. Injury was defined as any blunt, penetrating, or burn mechanism where the EMS provider(s) believed trauma to be the primary clinical insult. Patients were included if they had abnormal vital signs (SBP ≤ 90 mmHg, respiratory rate < 10 or > 29, or Glasgow Coma Scale score ≤ 12), were intubated in the field, or died in the field. The registry included 13,830 traumatic events from 264 EMS agencies transporting to 287 acute care hospitals from the following regional centers: Birmingham, Alabama; Dallas, Texas; Iowa City, Iowa; Milwaukee, Wisconsin; Pittsburgh, Pennsylvania; Portland, Oregon; San Diego, California; Seattle/King County, Washington; Ottawa, Ontario; Toronto, Ontario; and Vancouver, British Columbia.

Design

ROC Epistry collected standardized data regarding episode-specific factors, patient demographics, clinical information, pre-hospital interventions and disposition, hospital information, and patient outcome for all out-of-hospital traumatic injuries in the ROC regions. Cases were identified through review of emergency response system records including dispatch centers, EMS ground agencies, and air medical services. Out-of-hospital data were extracted from existing databases whenever possible and augmented with targeted review of EMS reports. Hospital data were abstracted directly from the hospital file in most cases. Sites submitted data using a web-based interface or batch uploads.

Newgard CD, Sears GK, Rea TD, et al. The Resuscitation Outcomes Consortium Epistry-Trauma: Design, Development, and Implementation of a North American Epidemiologic Prehospital Trauma Registry. Resuscitation. 2008;78(2):170-178. doi:10.1016/j.resuscitation.2008.01.029.

Conclusions

n/a

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