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Cited by 266Trauma and Emergency Care StudiesCardiac Arrest and ResuscitationTrauma, Hemostasis, Coagulopathy, Resuscitation

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

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Stiell, I. G., Nesbitt, L. P., Pickett, W., Munkley, D., Spaite, D. W., Banek, J., Field, B., Luinstra-Toohey, L. +6 more·2008·Canadian Medical Association Journal
DOI 10.1503/cmaj.071154PMC PMC2292763
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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.

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Authors
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., & for the OPALS Study Group
Affiliations
  • University of Ottawa (CA)
  • Western University (CA)
  • McMaster University (CA)
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Impact Inc.
Published
2008-04-22
Volume
178
Issue
9
Pages
1141-1152
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.071154
PMC
PMC2292763
OpenAlex
W2100588091
Cited by
266
References
0
Citations by year
2026: 7 · 2025: 5 · 2024: 5 · 2023: 13 · 2022: 11 · 2021: 14 · 2020: 14 · 2019: 13 · 2018: 11 · 2017: 12 · 2016: 12 · 2015: 21 · 2014: 20 · 2013: 14 · 2012: 31
FWCI
20.96
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Ottawa
  • Canadian Health Services Research Foundation
  • Ontario Ministry of Health and Long-Term Care
Topics
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
Keywords
prehospital advanced life support, severe trauma, trauma mortality, survival to hospital discharge, Glasgow Coma Scale, endotracheal intubation, emergency medical services, paramedics, trauma morbidity, blunt trauma
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Allied Health Personnel, Emergency Medical Services, Female, Fluid Therapy, Humans, Intubation, Intratracheal, Life Support Care, Male, Middle Aged, Ontario, Wounds and Injuries, Trauma Severity Indices, Logistic Models, Survival Analysis

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