Characteristics and outcomes of injured patients presenting by private vehicle in a state trauma system. Am J Emerg Med 2013 Feb;31(2):275-81
Date
09/25/2012Pubmed ID
23000329DOI
10.1016/j.ajem.2012.07.023Scopus ID
2-s2.0-84873640455 (requires institutional sign-in at Scopus site) 33 CitationsAbstract
BACKGROUND: Previous studies have demonstrated lower mortality among patients transported to single urban trauma centers by private vehicle (PV) compared with Emergency Medical Services (EMS). We sought to describe the characteristics and outcomes of injured patients transported by PV in a state trauma system compared to patients transported by EMS.
METHODS: We performed a retrospective cohort study of state trauma registry data for patients admitted to all Pennsylvania trauma centers over 5 years (1/2003 to 12/2007). Our primary exposure of interest was prehospital mode of transport and our primary outcome of interest was in-hospital mortality. Unadjusted analyses were performed as were adjusted analyses controlling for injury severity. Data are presented as percents, odds ratios (ORs), and 95% confidence intervals.
RESULTS: Of the 91132 patients analyzed, 9.6% were transported to the emergency department by PV and 90.4% by EMS. Overall Injury Severity Score (ISS) was 13.3 ± 11.0 (ISS for EMS 13.7 ± 11.3, PV 9.2 ± 7.1, P < .001), and 6.6% of patients died (EMS 7.1%, PV 1.5%, P < .001). After adjusting for injury severity, patients transported by EMS were more likely to die than PV patients (OR 1.9 [95% CI 1.5-2.4]). This effect persisted in blunt, penetrating, advanced life support, and basic life support subgroups, but not in the severely injured (ISS >15, ISS >25) subgroups.
CONCLUSIONS: Nearly 10% of injured patients arrive at trauma centers by private vehicle. Transport of injured patients by EMS was associated with higher mortality than PV transport. This may reflect the effects of prehospital time, prehospital interventions, or other confounders.
Author List
Johnson NJ, Carr BG, Salhi R, Holena DN, Wolff C, Band RAAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Cohort Studies
Female
Hospital Mortality
Humans
Injury Severity Score
Logistic Models
Male
Middle Aged
Odds Ratio
Pennsylvania
Registries
Retrospective Studies
Transportation of Patients
Wounds, Nonpenetrating
Wounds, Penetrating
