A Cochrane review [Abstract] 1 included one controlled before-and-after trial (n = 1880), one uncontrolled before-and-after study (n = 2867), and one randomised controlled trial (n = 16) examining the impact of advanced life support (ALS)-trained ambulance crews versus crews without ALS training on reducing mortality and morbidity in trauma patients. None demonstrated evidence to support ALS training in trauma life support for pre-hospital personnel. In the uncontrolled before-and-after study, 'a priori' sub-group analysis showed an increase in mortality among patients who had a Glasgow Coma Scale score of less than nine and received care from ALS trained ambulance crews. Additionally, when the pre-hospital trauma score was taken into account in logistic regression analysis, mortality in the patients receiving care from ALS trained crews increased significantly.
Comment: The quality of evidence is downgraded by severe study limitations (non-RCT design, poor protocol compliance, selective outcome reporting).
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