Citation

Zafar SN, Haider AH, Stevens KA, Ray-Mazumder N, Kisat MT, Schneider EB, Chi A, Galvagno SM, Cornwell EE, Efron DT, Haut ER. Injury 2014; 45(9): 1320-1326.

Affiliation

Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, United States. Electronic address: ehaut1@jhmi.edu.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.injury.2014.05.032

PMID

24957424

Abstract

BACKGROUND: Recent studies suggest that mode of transport affects survival in penetrating trauma patients. We hypothesised that there is wide variation in transport mode for patients with gunshot wounds (GSW) and there may be a mortality difference for GSW patients transported by emergency medical services (EMS) vs. private vehicle (PV). STUDY DESIGN: We studied adult (≥16 years) GSW patients in the National Trauma Data Bank (2007-2010). Level 1 and 2 trauma centres (TC) receiving ≥50 GSW patients per year were included. Proportions of patients arriving by each transport mode for each TC were examined. In-hospital mortality was compared between the two groups, PV and EMS, using multivariable regression analyses. Models were adjusted for patient demographics, injury severity, and were adjusted for clustering by facility.

RESULTS: 74,187 GSW patients were treated at 182 TCs. The majority (76%) were transported by EMS while 12.6% were transported by PV. By individual TC, the proportion of patients transported by each category varied widely: EMS (median 78%, interquartile range (IQR) 66-85%), PV (median 11%, IQR 7-17%), or others (median 7%, IQR 2-18%). Unadjusted mortality was significantly different between PV and EMS (2.1% vs. 9.7%, p<0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR=2.0, 95% CI 1.73-2.35).

CONCLUSIONS: Wide variation exists in transport mode for GSW patients across the United States. Mortality may be higher for GSW patients transported by EMS when compared to private vehicle transport. Further studies should be performed to examine this question.

Language: en