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

Syed Nabeel Zafar, Adil H. Haider, Kent A. Stevens, Nik Ray-Mazumder, Mehreen T. Kisat, Eric B. Schneider, Albert Chi, Samuel M. Galvagno, Edward E. Cornwell, David T. Efron, Elliott R. Haut

Research output: Contribution to journalArticle

18 Citations (Scopus)

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%, p < 0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR = 2.0, 95% CI 1.73-2.35). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1320-1326
Number of pages7
JournalInjury
Volume45
Issue number9
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Gunshot Wounds
Emergency Medical Services
Mortality
Trauma Centers
Wounds and Injuries
Hospital Mortality
Cluster Analysis

Keywords

  • Comparative effectiveness research
  • Emergency medical services
  • Firearm injury
  • Gunshot wounds
  • Mortality
  • Pre hospital care
  • Pre hospital transport
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Zafar, S. N., Haider, A. H., Stevens, K. A., Ray-Mazumder, N., Kisat, M. T., Schneider, E. B., ... Haut, E. R. (2014). Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport. Injury, 45(9), 1320-1326. https://doi.org/10.1016/j.injury.2014.05.032

Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport. / Zafar, Syed Nabeel; Haider, Adil H.; Stevens, Kent A.; Ray-Mazumder, Nik; Kisat, Mehreen T.; Schneider, Eric B.; Chi, Albert; Galvagno, Samuel M.; Cornwell, Edward E.; Efron, David T.; Haut, Elliott R.

In: Injury, Vol. 45, No. 9, 01.01.2014, p. 1320-1326.

Research output: Contribution to journalArticle

Zafar, SN, Haider, AH, Stevens, KA, Ray-Mazumder, N, Kisat, MT, Schneider, EB, Chi, A, Galvagno, SM, Cornwell, EE, Efron, DT & Haut, ER 2014, 'Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport', Injury, vol. 45, no. 9, pp. 1320-1326. https://doi.org/10.1016/j.injury.2014.05.032
Zafar, Syed Nabeel ; Haider, Adil H. ; Stevens, Kent A. ; Ray-Mazumder, Nik ; Kisat, Mehreen T. ; Schneider, Eric B. ; Chi, Albert ; Galvagno, Samuel M. ; Cornwell, Edward E. ; Efron, David T. ; Haut, Elliott R. / Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport. In: Injury. 2014 ; Vol. 45, No. 9. pp. 1320-1326.
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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{\%}, p < 0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR = 2.0, 95{\%} CI 1.73-2.35). Conclusions 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.",
keywords = "Comparative effectiveness research, Emergency medical services, Firearm injury, Gunshot wounds, Mortality, Pre hospital care, Pre hospital transport, Trauma",
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T1 - Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport

AU - Zafar, Syed Nabeel

AU - Haider, Adil H.

AU - Stevens, Kent A.

AU - Ray-Mazumder, Nik

AU - Kisat, Mehreen T.

AU - Schneider, Eric B.

AU - Chi, Albert

AU - Galvagno, Samuel M.

AU - Cornwell, Edward E.

AU - Efron, David T.

AU - Haut, Elliott R.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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%, p < 0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR = 2.0, 95% CI 1.73-2.35). Conclusions 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.

AB - 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%, p < 0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR = 2.0, 95% CI 1.73-2.35). Conclusions 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.

KW - Comparative effectiveness research

KW - Emergency medical services

KW - Firearm injury

KW - Gunshot wounds

KW - Mortality

KW - Pre hospital care

KW - Pre hospital transport

KW - Trauma

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