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Introduction In Taiwan, patients with major trauma are often sent to the closest non-trauma centre for initial resuscitation and transferred to distant trauma centres subsequently. This study aimed to evaluate the in-hospital mortality of severe trauma patients treated in a trauma centre versus in a non-trauma centre.Methods This prospective observational study reviewed 223 patients with major trauma (defined as Injury Severity Scale [ISS] score >15) who visited either a Level I trauma centre or a non-trauma centre from April 2013 to March 2014. Data of clinical status, trauma mechanisms, laboratory and radiology, interventions, and mortality/survival were evaluated. Logistic regression analysis was performed to assess effects of initial hospital treatment on mortality.Results A total of 158 major trauma patients were taken to the trauma centre hospital, and 65 patients were taken to the non-trauma centre. Age > 70 years (odds ratio [OR] 6.24, 95% confidence interval [CI] 1.01 to 38.62, compared to age ≤40 years), Glasgow Coma Scale [GCS] 3-8 (OR 19.00, 95% CI 2.30-157.01, compared to GCS 13-15), GCS 9-12 (OR 28.88, 95% CI 4.40-189.86, compared to GCS 13-15), ISS score >25 (OR 6.95, 95% CI 1.27-38.08) and taken to non-trauma centre initially (OR 30.90, 95% CI 5.00-191.27) were significantly associated with mortality.Conclusion Initial treatment of patients with major trauma in a non-trauma centre was associated with increased mortality compared to initial treatment in a trauma centre.

In Taiwan, patients with major trauma are often sent to the closest non-trauma centre for initial resuscitation and transferred to distant trauma centres subsequently. This study aimed to evaluate the in-hospital mortality of severe trauma patients treated in a trauma centre versus in a non-trauma centre. This prospective observational study reviewed 223 patients with major trauma (defined as Injury Severity Scale [ISS] score >15) who visited either a Level I trauma centre or a non-trauma centre from April 2013 to March 2014. Data of clinical status, trauma mechanisms, laboratory and radiology, interventions, and mortality/survival were evaluated. Logistic regression analysis was performed to assess effects of initial hospital treatment on mortality. A total of 158 major trauma patients were taken to the trauma centre hospital, and 65 patients were taken to the non-trauma centre. Age > 70 years (odds ratio [OR] 6.24, 95% confidence interval [CI] 1.01 to 38.62, compared to age =40 years), Glasgow Coma Scale [GCS] 3-8 (OR 19.00, 95% CI 2.30-157.01, compared to GCS 13-15), GCS 9-12 (OR 28.88, 95% CI 4.40-189.86, compared to GCS 13-15), ISS score >25 (OR 6.95, 95% CI 1.27-38.08) and taken to non-trauma centre initially (OR 30.90, 95% CI 5.00-191.27) were significantly associated with mortality. Initial treatment of patients with major trauma in a non-trauma centre was associated with increased mortality compared to initial treatment in a trauma centre.

Introduction To identify factors associated with ST-segment myocardial infarction (STEMI) patients who had no chest pain, and to improve recognition of STEMI patients without presentation of chest pain in the emergency department (ED).Method Clinical characteristics and presentations were recorded in patients diagnosed with STEMI in the ED in a retrospective study of patients treated from 2006 to 2009. Patients with and without chest pain were compared according to clinical features.Results Among 260 STEMI patients, 12.7% of patients had no chest pain presentation in the ED. Syncope, epigastric pain, and dyspnea accounted for more than 60% of symptoms in STEMI patients without chest pain. Diabetes mellitus (DM), cerebrovascular accident (CVA), and old age were risk factors for STEMI patients without chest pain.Conclusions DM, CVA, and elderly patients are more likely to be without chest pain when STEMI occurred.

To identify factors associated with ST-segment myocardial infarction (STEMI) patients who had no chest pain, and to improve recognition of STEMI patients without presentation of chest pain in the emergency department (ED). Clinical characteristics and presentations were recorded in patients diagnosed with STEMI in the ED in a retrospective study of patients treated from 2006 to 2009. Patients with and without chest pain were compared according to clinical features. Among 260 STEMI patients, 12.7% of patients had no chest pain presentation in the ED. Syncope, epigastric pain, and dyspnea accounted for more than 60% of symptoms in STEMI patients without chest pain. Diabetes mellitus (DM), cerebrovascular accident (CVA), and old age were risk factors for STEMI patients without chest pain. DM, CVA, and elderly patients are more likely to be without chest pain when STEMI occurred.