Association of Pre-hospital Mode of Transport With Mortality in Penetrating Trauma


Key Points
Question: Does ground emergency medical services transport confer a survival advantage vs. private vehicle transport for patients with penetrating injuries?

Findings: In this cohort study of 103,029 patients included in the National Trauma Data Bank, individuals transported by private vehicle were significantly less likely to die than similarly injured patients transported by ground emergency medical services, even when controlling for injury severity.

Meaning: Ground emergency medical services transport is not associated with improved survival compared with private vehicle transport among patients with penetrating injuries in urban trauma systems, suggesting pre-hospital trauma care may have a limited role in this subset of patients.

Abstract
Importance: Time to definitive care following injury is important to the outcomes of trauma patients. Pre-hospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in pre-hospital care policies across trauma systems, potentially affecting patient outcomes.

Objective: To evaluate whether private vehicle pre-hospital transport confers a survival advantage vs. ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems.

Design, Setting, and Participants: Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle.

Main Outcome and Measure In-hospital mortality.

Results: Of the 2,329,446 records assessed for eligibility, 103,029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR, 0.45; 95% CI, 0.36-0.56) and stab wound (OR, 0.32; 95% CI, 0.20-0.52) subgroups.

Conclusions and Relevance: Private vehicle transport is associated with a significantly lower likelihood of death when compared with ground EMS transport for individuals with gunshot wounds and stab wounds in urban US trauma systems. System-level evidence such as this can be a valuable tool for those responsible for developing and implementing policies at the trauma system level.

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