Effects of mode and time of EMS transport on the rate and distribution of dead on arrival among trauma population transported to ACSCOT-verified trauma centers in the United States

Elkbuli, Adel; Boserup, Brad; Sen-Crowe, Brendon; Autrey, Cody; McKenney, Mark

doi:10.1016/j.ajem.2021.08.035

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…Emergency medical services (EMS) or ground ambulances provide vital transportation to health care systems for trauma patients and offer benefits including resuscitation with fluids and/or blood products, interventions for identified injuries, and notifying hospital systems of specific triage needs. 1 Outcomes of ground ambulance (here-on referred to as ambulance) have been compared to helicopter EMS; 2,3 however, outcomes of patients using private and public transport are understudied.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Trauma “Walk-Ins” in the American College of Surgeons Trauma Quality Program Database

Syamal,

Tran,

Huang

et al. 2023

The American Surgeon™

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Background Outcomes of trauma “walk-in” patients (using private vehicles or on foot) are understudied. We compared outcomes of ground ambulance vs walk-ins, hypothesizing that delayed resuscitation and uncoordinated care may worsen walk-in outcomes. Methods A retrospective analysis 2020 American College of Surgeons Trauma Quality Programs (ACS-TQP) databases compared outcomes between ambulance vs “walk-ins.” The primary outcome was in-hospital mortality, excluding external facility transfers and air transports. Data was analyzed with descriptive statistics, bivariate, multivariable logistic regression, including an Inverse Probability Weighted Regression Adjustment with adjustments for injury severity and vital signs. The primary outcome for the 2019 (pre-COVID-19 pandemic) data was similarly analyzed. Results In 2020, 707,899 patients were analyzed, 556,361 (78.59%) used ambulance, and 151,538 (21.41%) were walk-ins. We observed differences in demographics, hospital attributes, medical comorbidities, and injury mechanism. Ambulance patients had more chronic conditions and severe injuries. Walk-ins had lower in-hospital mortality (850 (.56%) vs 23,131 (4.16%)) and arrived with better vital signs. Multivariable logistic regression models (inverse probability weighting for regression adjustment), adjusting for injury severity, demographics, injury mechanism, and vital signs, confirmed that walk-in status had lower odds of mortality. For the 2019 (pre-COVID-19 pandemic) database, walk-ins also had lower in-hospital mortality. Discussion Our results demonstrate better survival rates for walk-ins before and during COVID-19 pandemic. Despite limitations of patient selection bias, this study highlights the need for further research into transportation modes, geographic and socioeconomic factors affecting patient transport, and tailoring management strategies based on their mode of arrival.

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Section: Introductionmentioning

confidence: 99%