Prospective Observational Study Assessing Patient Characteristics, Management and Early Outcomes of Major Trauma Patients With Prehospital Shock. A preliminary report of the Sydney COAST study

OBJECTIVE: Despite advances in trauma resuscitation, significant gaps remain in understanding how early physiological and biochemical derangements influence clinical outcomes. The Sydney 'Clinical Outcomes following Acute Shock in Trauma' (COAST) registry was developed by clinicians containing both prehospital and in-hospital data, allowing for the identification of risk factors that influence early mortality for major trauma patients with shock. This study reports the formation of the registry and the patient cohort enrolled over its first 12 months. METHODS: A multi-centre, prospective registry of shocked adult trauma patients treated by prehospital medical teams and transported directly to a Sydney-based major trauma centre. Shock was defined as either (1) systolic blood pressure less than 100 mmHg, (2) shock index greater than one, (3) blood transfusion or (4) administration of inotropes. Descriptive statistics were used to report outcomes including injuries, pathology, transfusions, immediate intervention, mortality and length of stay. RESULTS: Two hundred fifty seven patients were enrolled. The predominant shock criteria for inclusion was hypotension (90% of cases), whilst 53% received prehospital blood transfusion. Interventional haemorrhage control was required in 31% of cases, whilst 74% received in-hospital transfusion. Injury severity was high (median injury severity score of 27). Four-hour mortality was 4.7% (9% at 24-h and 21% at 30-days). CONCLUSIONS: Consistent with recent observational studies, the Sydney COAST registry captured a cohort of critically ill trauma patients, not all of whom may have had haemorrhage. This will serve as an important dataset, allowing clinicians to better understand factors driving traumatic shock whilst exploring avenues for improving care in these cases.