Paramedic vs private transportation of trauma patients. Effect on outcome
D. Demetriades, L. Chan, E. Cornwell, H. Belzberg, T. V. Berne, J. Asensio, D. Chan, M. Eckstein and K. Alo
Department of Surgery, Los Angeles Medical Center, Los Angeles, USA.
BACKGROUND: Prehospital emergency medical services (EMS) play a major role
in any trauma system. However, there is very little information regarding
the role of prehospital emergency care in trauma. To investigate this
issue, we compared the outcome of severely injured patients transported by
paramedics (EMS group) with the outcome of those transported by friends,
relatives, bystanders, or police (non-EMS group). DESIGN: We compared 4856
EMS patients with 926 non-EMS patients. General linear model analysis was
performed to test the hypothesis that hospital mortality is the same in EMS
and non-EMS cases, controlling for the following confounding factors, which
are not affected by mode of transportation: age, gender, mechanism of
injury, cause of injury, Injury Severity Score (ISS), and severe head
injury. Crude, specific, and adjusted mortality rates and relative risks
were also derived for the EMS and non-EMS groups. SETTING: Large, urban,
academic level I trauma center. PATIENTS: All patients meeting the criteria
for major trauma. RESULTS: The two groups were similar with regard to
mechanism of injury and the need for surgery or intensive care unit
admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in
the non-EMS group (relative risk, 2.32; P < .001). After adjustment for
ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that
among patients with ISS greater than 15, those in the EMS group had a
mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%).
After controlling for confounding factors, the adjusted mortality among
patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for
the non-EMS group (P < .001). CONCLUSIONS: Patients with severe trauma
transported by private means in this setting have better survival than
those transported via the EMS system. Large prospective studies are needed
to identify the factors responsible for this difference.
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