If you have asked a loved one – to no avail – to come to a hospital after a fall, you should both know about the "golden hour".
The “golden hour” is the first hour immediately after trauma – without exception before the hospital – when the patient needs treatment before death or disability is imminent.
Doctors have been aware of the golden hour for decades. It has been extensively studied over the years with varying conclusions.
Researchers from the National Taiwan University Hospital Yunlin Branch looked at the concept of the golden hour when they examined 24,000 trauma patients in Japan, Malaysia, Korea, and Taiwan. The mean age of the examined patients was 45 years. All hospitals involved in the investigation are academic teaching hospitals with functional trauma resuscitation skills.
The study, published in PLOS Medicine, examined a database of records from patients who were hospitalized by emergency medical services (EMS) between 2016 and 2018. Factors such as age, gender, pre-existing illnesses and the type and severity of the injury were adjusted.
Since trauma accounts for 0.5% of annual mortality worldwide, the goal of the research was to understand whether the golden hour exists by determining the influence of time before the hospital on patient outcomes.
While a patient's length of pre-clinical time was not related to the risk of dying within 30 days of the injury or accident, the study found that the likelihood of poor functional outcome increased by 6% with every 10-minute delay before hospitalization. increased hospital time. A total of more than 50 minutes in front of the hospital also predicted poor results.
The study supported the concept of the golden hour. Researchers recommended rapid transportation and reducing the time before hospitalization to improve a patient's functional outcomes.
The cost of delaying treatment
Orthopedic surgeons frequently deal with patients who believe it is okay to postpone treatment, said Dr. Brad G. Prybis, a spinal surgeon at AICA Orthopedics in Atlanta, told Medical Daily.
"Regarding the golden hour or even the 24-hour window, we always recommend seeing a doctor if a patient has suffered an injury, be it a fall, trauma or something less severe," said Dr. Prybis.
The Taiwanese study assessed potential factors that affect the time before hospitalization. The hope is to help EMS teams reduce pre-hospital time and develop guidelines and best practices to support them.
Delays before hospitalization can occur for a variety of reasons. This includes emergency response times, scene control, rescue measures and transport time. A patient who initially refuses treatment also plays a role.
Get treatment right away for the best results
The researchers found no association between time before hospitalization and 30-day mortality. However, the total pre-hospital stay and response times affected the functional outcomes of the patients. Functional outcomes are an index of neurological status that predicts quality of life and the ability to return to normal life and work.
"In our experience, injuries keep getting worse, and the more people postpone treatment, the more damage can occur in their lifetime," said Dr. Prybis.
“It never hurts to have at least a doctor examine you, even if the patient already thinks that they will not receive certain treatments. It is important to speak to a doctor and allow them to evaluate the injuries. "