Revisiting the “Golden Hour”: An Evaluation of Out-of-Hospital Time in Shock and Traumatic Brain Injury  Craig D. Newgard‎, MD, MPH, Eric N. Meier, MS,

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Revisiting the “Golden Hour”: An Evaluation of Out-of-Hospital Time in Shock and Traumatic Brain Injury  Craig D. Newgard‎, MD, MPH, Eric N. Meier, MS, Eileen M. Bulger, MD, Jason Buick, MSc, PCPf, Kellie Sheehan, BSN, Steve Lin, MD, MSc, Joseph P. Minei, MD, Roxy A. Barnes-Mackey, RN, Karen Brasel, MD, MPH  Annals of Emergency Medicine  Volume 66, Issue 1, Pages 30-41.e3 (July 2015) DOI: 10.1016/j.annemergmed.2014.12.004 Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 1 Flow diagram of patients included in the primary analysis. SBP, Systolic blood pressure; HR, pulse rate; TBI, traumatic brain injury; GOSE, Glasgow Outcome Scale–Extended. *Both cohorts include 4 patients for whom there were insufficient data to determine a specific cohort. For all 4, the study kit had been opened, but no fluid was infused. †No qualifying vital signs were recorded or no traumatic mechanism. The qualifying SBP must have been less than or equal to 70 or 71 to 90 mm Hg, accompanied by a pulse rate greater than or equal to 108 beats/min. ‡No GCS score less than or equal to 8 was recorded before enrollment or met shock cohort criteria after shock enrollment was closed. §Two regional sites had fewer than 4 eligible patients in each of the cohorts. Patients enrolled from these sites were excluded from this analysis. Annals of Emergency Medicine 2015 66, 30-41.e3DOI: (10.1016/j.annemergmed.2014.12.004) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 2 Total out-of-hospital time and unadjusted primary outcomes for the shock cohort (A) (n=778) and traumatic brain injury cohort (B) (n=1,239).* *Includes imputed values for 6-month GOSE. x Axis has been truncated at 120 minutes in both cohorts for clarity. Annals of Emergency Medicine 2015 66, 30-41.e3DOI: (10.1016/j.annemergmed.2014.12.004) Copyright © 2015 American College of Emergency Physicians Terms and Conditions

Figure 3 Subgroup analyses for shock (outcome=28-day mortality) and traumatic brain injury (outcome=6-month GOSE score ≤4) cohorts, using multivariable models and a dichotomous out-of-hospital time variable (>60 versus ≤60 minutes). OOH, Out of hospital. Annals of Emergency Medicine 2015 66, 30-41.e3DOI: (10.1016/j.annemergmed.2014.12.004) Copyright © 2015 American College of Emergency Physicians Terms and Conditions