Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport

Authors

Syed Nabeel Zafar, Howard University Hospital, Washington
Adil H. Haider, The Johns Hopkins University School of Medicine, BaltimoreFollow
Kent A. Stevens, The Johns Hopkins University School of Medicine, Baltimore
Nik Ray-Mazumder, The Johns Hopkins University School of Medicine, Baltimore
Mehreen T. Kisat, University of Arizona, Tucson
Eric B. Schneider, The Johns Hopkins University School of Medicine, Baltimore
Albert Chi, The Johns Hopkins University School of Medicine, Baltimore
Samuel M. Galvagno Jr, University of Maryland School of Medicine, Baltimore
Edward E. Cornwell, Howard University College of Medicine, Washington
David T. Efron, The Johns Hopkins University School of Medicine, Baltimore

Document Type

Article

Department

General Surgery

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%, pConclusions: 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.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Injury

Recommended Citation

Zafar, S. N., Haider, A. H., Stevens, K. A., Ray-Mazumder, N., Kisat, M. T., Schneider, E. B., Chi, A., Galvagno Jr, S. M., Cornwell, E. E., Efron, D. T. (2014). Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport. Injury, 45(9), 1320-1326.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/146