Exploring the golden hour: Delays in trauma treatment linked to disability and death

Some clinicians consider that after a traumatic injury, patients are most likely to survive if they receive medical treatment within one hour—the so-called "golden hour." A new study led by Chiang Wen-Chu at National Taiwan University Hospital, Yunlin Branch, and published October 6th, 2020 in PLOS Medicine, explores that idea, finding that longer delays in treatment could increase a patient's risk of disability or death.

While the concept of the golden hour was first proposed in the 20th century, studies have offered conflicting results over whether treatment in the first hour is vital to survival. Wen-Chu and his colleagues investigated this idea through a retrospective study of more than 24,000 trauma patients in Japan, Malaysia, Korea and Taiwan, who were transported to a hospital by emergency services between 2016 and 2018. The authors used statistical methods to identify relationships between the "prehospital time" before treatment and patient outcomes, taking into account factors such as age, sex, type and severity of the injury, and any prehospital medical treatments. Overall, the length of prehospital time was not related to a patient's risk of dying within 30 days of the trauma incident, but every 10-minute delay was associated with a 6% increase (95% confidence intervals 4-8%, p<0.001) in the odds of a poor outcome, such as a severe disability.

The authors support the idea of the golden hour because their findings suggest that rapid transportation may be associated with reduced risk that a patient will suffer poor quality of life or be unable to return to normal daily activities after an injury. Multiple factors can affect how long it takes a trauma patient to reach the hospital, including the response speed of emergency services, the distance to the hospital and the severity of the patient's condition. Additionally, the authors urge emergency services staff to make the most of that prehospital time, to promote the best possible outcomes for patients.