Severity-Adjusted Mortality in Trauma Patients Transported by Police - 18/04/14
, Rama A. Salhi, BS, MHS c, Daniel N. Holena, MD b, Elizabeth Powell, MD a, Charles C. Branas, PhD c, Brendan G. Carr, MD, MS a, b, cAbstract |
Study objective |
Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia.
Methods |
This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index.
Results |
Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police.
Conclusion |
We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 609 for the Editor's Capsule Summary of this article. |
|
| A 8MNR35K survey is available with each research article published on the Web at www.annemergmed.com. |
|
| A podcast for this article is available at www.annemergmed.com. |
|
| Supervising editor: Kathy J. Rinnert, MD, MPH |
|
| Author contributions: RAB and BGC conceived and designed the study. RAB, RAS, and BGC supervised the conduct of the trial and the data collection and managed the data. RAS and BGC provided statistical advice on study design and analyzed the data. RAB, EP, and BGC drafted the article, and all authors contributed substantially to its revision. RAB takes responsibility for the paper as a whole. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). Dr. Carr spends a portion of his time as a Senior Policy Analyst in the Office of the Assistant Secretary for Preparedness and Response. The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Department of Health and Human Services or its components. Dr. Carr is supported by a career development award from the Agency for Healthcare Research and Quality (AHRQ) (K08HS017960). Dr. Carr receives research funding from the AHRQ, the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the American Heart Association. Dr. Branas receives research funding from the AHRQ, the NIH, and the CDC. |
|
| These data were provided by the Pennsylvania Trauma Systems Foundation, Mechanicsburg, PA. The foundation specifically disclaims responsibility for any analyses, interpretations, or conclusions. The Philadelphia Police Department has recently issued tourniquets to every police officer in the city. |
Vol 63 - N° 5
P. 608 - mai 2014 Retour au numéro
Article précédent
- Effect of Out-of-Hospital Noninvasive Positive-Pressure Support Ventilation in Adult Patients With Severe Respiratory Distress: A Systematic Review and Meta-analysis
- Sameer Mal, Shelley McLeod, Alla Iansavichene, Adam Dukelow, Michael Lewell
- Should Payment Policy Be Changed to Allow a Wider Range of EMS Transport Options?
- Kristy G. Morganti, Abby Alpert, Gregg Margolis, Jeffrey Wasserman, Arthur L. Kellermann
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?