Prehospital Determinants of Emergency Department Mortality in Adult Trauma at a South Sumatran Tertiary Referral Centre: A Cross-Sectional Study with Penalised-Likelihood Reanalysis

Abstract

Background: The prehospital phase is considered a modifiable determinant of trauma survival, but evidence from Indonesian tertiary centres with under-developed emergency medical services is scarce.

Objective: To examine whether first-responder type, scene time and transport mode were associated with emergency department mortality in adult trauma.

Methods: This cross-sectional study included 34 consecutive adult trauma patients presenting to the Emergency Department of Dr. Mohammad Hoesin General Hospital, Palembang. Associations were assessed using Fisher exact tests, exact conditional odds ratios (OR), Newcombe risk differences, Firth penalised logistic regression and the originally specified multivariable model. Minimum detectable effects and post-hoc power were calculated.

Results: Mortality was 20.6% (7/34; 95% CI 10.3–36.8). Death occurred in 6/24 patients with scene time >60 minutes versus 1/10 with shorter scene time (OR 2.92, 95% CI 0.28–153.08; p = 0.644), in 1/2 transported by ambulance versus 6/32 otherwise (OR 4.09, 95% CI 0.05–352.85; p = 0.374), and in 1/2 attended by a medical first responder versus 6/32 attended by lay rescuers (p = 0.374). No exposure was independently associated with mortality. The smallest detectable OR was 12.57; realised power was 12.6–23.1%.

Conclusion: No prehospital factor was significantly associated with mortality, but the wide intervals remain compatible with clinically important effects. The findings are uninformative rather than negative and support a prospective, adequately powered, biomarker-augmented regional trauma registry.