Factors Associated with Survival in Adult Trauma Patients Transported to US Trauma Centers by Police

Colnaric, Jure; Bachir, Rana; Sayed, Mazen J. El

doi:10.1017/s1049023x20001314

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Consistent with a previous report from Malawi, transportation to the hospital by the police was the most predictive factor of an early death, increasing the risk by nearly 50% [17]. The role of police in transporting injured patients from the scene has been controversial in the United States, with conflicting evidence about the safety and timeliness of transfer [18][19][20]. Data from neighboring countries in sub-Saharan Africa have been mixed, with some reports showing no adverse outcomes related to police transport [21,22].…”

Section: Discussionsupporting

confidence: 59%

Tri‐modal Distribution of Trauma Deaths in a Resource‐Limited Setting: Perception Versus Reality

Gallaher

Kayange

et al. 2023

World j. surg.

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Background Advances in trauma care in high‐income countries have significantly reduced late deaths following trauma, challenging the classical trimodal pattern of trauma‐associated mortality. While studies from low and middle‐income countries have demonstrated that the trimodal pattern is still occurring in many regions, there is a lack of data from sub‐Saharan Africa evaluating the temporal epidemiology of trauma deaths. Methods We conducted a retrospective analysis of the trauma registry at Kamuzu Central Hospital in Lilongwe, Malawi, including all injured patients presenting to the emergency department (ED) from 2009 to 2021. Patients were compared based on timing of death relative to time of injury. We then used a modified Poisson regression model to identify adjusted predictors for early mortality compared to late mortality. Results Crude mortality of patients presenting to the ED in the study period was 2.4% (n = 4,096/165,324). Most patients experienced a pre‐hospital death (n = 2,330, 56.9%), followed by death in the ED (n = 619, 15.1%). Early death (pre‐hospital or ED) was associated with transportation by police (RR1.52, 95% CI 1.38, 1.68) or private vehicle (RR1.20, 95% CI 1.07, 1.31), vehicle‐related trauma (RR1.10, 95% CI 1.05, 1.14), and penetrating injury (RR1.11, 95% CI 1.04, 1.19). Ambulance transportation was associated with a 40% decrease in the risk of early death. Conclusions At a busy tertiary trauma center in Malawi, most trauma‐associated deaths occur within 48 h of injury, with most in the pre‐hospital setting. To improve clinical outcomes for trauma patients in this environment, substantial investment in pre‐hospital care is required through first‐responder training and EMS infrastructure.

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Section: Discussionsupporting

confidence: 59%

Tri‐modal Distribution of Trauma Deaths in a Resource‐Limited Setting: Perception Versus Reality

Gallaher

Kayange

et al. 2023

World j. surg.

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“…9,14 A previous study assessing factors associated with survival of trauma patients transported by police showed that ISS along with other factors such as a GCS ≤ 8 and a SBP below 90mmHg were associated with lower survival to hospital discharge. 13 Beyond the potential medical benefits, incorporating PT of trauma patients to hospitals can be associated with positive outcomes. In previous studies out of the US, patients transported by police belonged to racial minority groups that have little a "Other" is the combination of the following nature of injuries: Amputations, Burns, Crush, Dislocation, Nerves, Sprains & Strains, System Wide & Late Effects, Unspecified.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study using the US National Trauma Data Bank (NTDB; American College of Surgeons; Chicago, Illinois USA) showed a high survival rate (93.5%) for trauma patients who were transported by police when compared to previous survival rates of trauma patients transported by EMS in other studies. 13 Current evidence regarding penetrating trauma patient outcomes in police transport (PT) is scarce. Previous studies showed that PT of penetrating injuries is not associated with a mortality difference when compared to EMS transport of similar injuries, 10 and some showed improved survival with PT in sub-group analysis including only severely injured patients.…”

Section: Introductionmentioning

confidence: 99%

Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Arbid

Bachir

Sayed

2022

Prehosp. Disaster med.

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Introduction: Police transport (PT) of penetrating trauma patients has the potential to improve survival rates. There are no well-established guidelines for PT of penetrating trauma patients. Study Objective: This study examines the association between survival rate to hospital discharge of adult penetrating trauma patients and mode of transport (PT versus ground ambulance [GA]). Methods: A retrospective, matched cohort study was conducted using the United States (US) National Trauma Data Bank (NTDB). All adult penetrating injury patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by GA for analysis. Descriptive analysis was carried out. The patients’ demographic and clinical characteristics were tabulated and stratified by the transport mode. Results: Out of the 733 patients with penetrating injuries, ground Emergency Medical Services (EMS) transported 513 patients and police transported 220 patients. Most patients were 16-64 years of age with a male (95.6%) and Black/African American race (79.0%) predominance. Firearm-related injuries (68.8%) were the most common mechanism of injury with the majority of injuries involving the body extremities (62.9%). Open wounds were the most common nature of injury (75.7%). The overall survival rate to hospital discharge was similar for patients transported by GA and by police (94.5% versus 92.7%; P = .343). Conclusion: In this study, patients with penetrating trauma transported by police had similar outcomes to those transported by GA. As such, PT in penetrating trauma appears to be effective. Detailed protocols should be developed to further improve resource utilization and outcomes.

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“…8,30 Significant differences in terms of survival are reported when studies take into consideration variation in prehospital times. 8,9,31 Factors associated with survival in patients transported by police were previously examined, 10 and blunt trauma mainly from motor vehicle traffic was identified to be a significant positive predictor of survival.…”

Section: Discussionmentioning

confidence: 99%

“…8 Involvement of police in trauma transport is based on the principle of the golden hour, which pertains to efficient prehospital care and rapid arrival to the hospital. 9,10 As law enforcement, officers usually arrive at the trauma incident location prior to ground ambulance; they are increasingly involved in prehospital care and rapid transport to the ED. [11][12][13][14] In Philadelphia (Pennsylvania USA), a well-defined prehospital protocol requires law enforcement officers to transport penetrating trauma patients to the nearest trauma center since 1996.…”

Section: Introductionmentioning

confidence: 99%

Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Sakr

Bachir

Sayed

2021

Prehosp. Disaster med.

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Introduction: Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. Study Objective: This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). Methods: A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation. Results: Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). Conclusion: In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.

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Factors Associated with Survival in Adult Trauma Patients Transported to US Trauma Centers by Police

Cited by 6 publications

References 18 publications

Tri‐modal Distribution of Trauma Deaths in a Resource‐Limited Setting: Perception Versus Reality

Tri‐modal Distribution of Trauma Deaths in a Resource‐Limited Setting: Perception Versus Reality

Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

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