Prehospital Determinants of Emergency Department Mortality in Adult Trauma at a South Sumatran Tertiary Referral Center: A Retrospective Cross-Sectional Study

Abstract

Background: Prehospital care is a modifiable determinant of trauma survival, but evidence from Indonesian referral centers without integrated emergency medical services is scarce.

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

Methods: This retrospective cross-sectional study (STROBE) analyzed 34 consecutive adult trauma patients at the Emergency Department of Dr. Mohammad Hoesin General Hospital, Palembang. Associations were assessed with Fisher exact tests, exact conditional and Haldane–Anscombe odds ratios (OR), Newcombe risk differences, univariable Firth penalized logistic regression, and a multivariable model. Power, minimum detectable ORs, and reverse fragility indices were calculated.

Results: Mortality was 20.6% (7/34; 95% CI: 10.3–36.8%). Lay rescuers attended 94.1% (32/34) of patients, 94.1% (32/34) arrived by non-ambulance transport, and 70.6% (24/34) had prehospital times >60 minutes (mean 116.47 ± 55.10 minutes). Death occurred in 6/24 (25.0%) patients with prehospital time >60 minutes versus 1/10 (10.0%) with ≤60 minutes (exact conditional OR 2.92, 95% CI: 0.28–153.08; Firth OR 2.23, 95% CI: 0.38–23.63; Fisher p = 0.644), and in 1/2 (50.0%) versus 6/32 (18.8%) for both ambulance transport and medical responder (exact conditional OR 4.09, 95% CI: 0.05–352.85; Firth OR 4.08, 95% CI: 0.29–57.01; p = 0.374). No exposure was associated with mortality in multivariable analysis (p = 0.492; minimum detectable OR 12.57–69.82; power 12.6–23.1%).

Conclusion: No prehospital factor was significantly associated with mortality, but wide intervals and low power make these findings uninformative rather than negative; they support lay-responder training and a prospective regional trauma registry.