Citation

Maher Z, Beard JH, Dauer E, Carroll M, Forman S, Topper GV, Pathak A, Santora TA, Sjoholm LO, Zhao H, Goldberg AJ. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003225

PMID

unavailable

Abstract

BACKGROUND: Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is increasing and that these patients are more injured.

METHODS: We conducted a single-center, retrospective cohort study of adult (≥ 18 years) patients presenting with gunshot wounds (GSWs) to a Level 1 center from 2012-2018. Patients transported by police or ambulance (EMS) were included. The association between mode of transport (PT vs. EMS) and mortality was evaluated using chi-square, t-tests, Mann-Whitney u tests, and logistic regression.

RESULTS: Of 2,007 patients, there were 1,357 PT patients and 650 EMS patients. Overall in-hospital mortality was 23.7%. The rate of GSW patients arriving by PT increased from 48.9 to 78.5% over the study period (p < 0.001). Compared to EMS patients, PT patients were sicker on presentation with lower initial SBP (98 vs. 110, p < 0.001), higher ISS (median [IQR], 10 [2-75] vs 9 [1-17], p < 0.001) and more bullet wounds (3.5 vs. 2.9, p < 0.001). PT patients more frequently underwent resuscitative thoracotomy (19.2% vs 10.0%, p < 0.001) and immediate surgical exploration (31.3% vs. 22.6%, p < 0.001). There was no difference in adjusted in-hospital mortality between transport groups. Of patients surviving to discharge, PT patients had higher ISS (9.6 vs. 8.3, p=0.004) and lower SBP on arrival (126 vs. 130, p=0.013) than EMS patients.

CONCLUSIONS: Police transport of GSW patients is increasing at our urban, Level 1 center. Compared to EMS patients, PT patients are more severely injured but have similar in-hospital mortality. Further study is necessary to understand the impact of PT on outcomes in specific subsets in penetrating trauma patients. LEVEL OF EVIDENCE: Level III. STUDY TYPE: Therapeutic/Care Management.

Language: en