BACKGROUND: Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers. METHODS: A retrospective cohort study was conducted at an urban Level I trauma center. Victims of penetrating trauma transported by ALS, BLS, or police from January 1, 2008, to November 31, 2013, were identified. Patient survival by mode of transport and by level of care received was analyzed using logistic regression. RESULTS: During the study period, 1,490 penetrating trauma patients were transported by ALS (44.8%), BLS (15.6%), or police (39.6%) personnel. The majority of injuries were gunshot wounds (72.9% for ALS, 66.8% for BLS, 90% for police). Median transport minutes were significantly longer for ALS (16 minutes) than for BLS (14.5 minutes) transports (p = 0.012). After adjusting for transport time and Injury Severity Score (ISS), among victims with an ISS of 0 to 30, there was a 2.4-fold increased odds of death (95% confidence interval [CI], 1.3-4.4) if transported by ALS as compared with BLS. With an ISS of greater than 30, this relationship did not exist (odds ratio, 0.9; 95% CI, 0.3-2.7). When examined by type of care provided, patients with an ISS of 0 to 30 given ALS support were 3.7 times more likely to die than those who received BLS support (95% CI, 2.0-6.8). Among those with an ISS of greater than 30, no relationship was evident (odds ratio, 0.9; 95% CI, 0.3-2.7). CONCLUSION: Among penetrating trauma victims with an ISS of 30 or lower, an increased odds of death was identified for those treated and/or transported by ALS personnel. For those with an ISS of greater than 30, no survival advantage was identified with ALS transport or care. Results suggest that rapid transport may be more important than increased interventions. LEVEL OF EVIDENCE: Therapeutic study, level IV.
BACKGROUND: Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers. METHODS: A retrospective cohort study was conducted at an urban Level I trauma center. Victims of penetrating trauma transported by ALS, BLS, or police from January 1, 2008, to November 31, 2013, were identified. Patient survival by mode of transport and by level of care received was analyzed using logistic regression. RESULTS: During the study period, 1,490 penetrating traumapatients were transported by ALS (44.8%), BLS (15.6%), or police (39.6%) personnel. The majority of injuries were gunshot wounds (72.9% for ALS, 66.8% for BLS, 90% for police). Median transport minutes were significantly longer for ALS (16 minutes) than for BLS (14.5 minutes) transports (p = 0.012). After adjusting for transport time and Injury Severity Score (ISS), among victims with an ISS of 0 to 30, there was a 2.4-fold increased odds of death (95% confidence interval [CI], 1.3-4.4) if transported by ALS as compared with BLS. With an ISS of greater than 30, this relationship did not exist (odds ratio, 0.9; 95% CI, 0.3-2.7). When examined by type of care provided, patients with an ISS of 0 to 30 given ALS support were 3.7 times more likely to die than those who received BLS support (95% CI, 2.0-6.8). Among those with an ISS of greater than 30, no relationship was evident (odds ratio, 0.9; 95% CI, 0.3-2.7). CONCLUSION: Among penetrating trauma victims with an ISS of 30 or lower, an increased odds of death was identified for those treated and/or transported by ALS personnel. For those with an ISS of greater than 30, no survival advantage was identified with ALS transport or care. Results suggest that rapid transport may be more important than increased interventions. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors: Michael S Farrell; Benjamin Emery; Richard Caplan; John Getchell; Mark Cipolle; Kevin M Bradley Journal: Am J Surg Date: 2020-01-22 Impact factor: 2.565
Authors: Sharven Taghavi; Zoe Maher; Amy J Goldberg; Grace Chang; Michelle Mendiola; Christofer Anderson; Scott Ninokawa; Leah C Tatebe; Patrick Maluso; Shariq Raza; Jane J Keating; Sigrid Burruss; Matthew Reeves; Lauren E Coleman; David V Shatz; Anna Goldenberg-Sandau; Apoorva Bhupathi; M Chance Spalding; Aimee LaRiccia; Emily Bird; Matthew R Noorbakhsh; James Babowice; Marsha C Nelson; Lewis E Jacobson; Jamie Williams; Michael Vella; Kate Dellonte; Thomas Z Hayward; Emma Holler; Mark J Lieser; John D Berne; Dalier R Mederos; Reza Askari; Barbara U Okafor; Elliott R Haut; Eric W Etchill; Raymond Fang; Samantha L Roche; Laura Whittenburg; Andrew C Bernard; James M Haan; Kelly L Lightwine; Scott H Norwood; Jason Murry; Mark A Gamber; Matthew M Carrick; Nikolay Bugaev; Antony Tatar; Juan Duchesne; Danielle Tatum Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.313
Authors: Alexander F Bedard; Lina V Mata; Chelsea Dymond; Fabio Moreira; Julia Dixon; Steven G Schauer; Adit A Ginde; Vikhyat Bebarta; Ernest E Moore; Nee-Kofi Mould-Millman Journal: Int J Emerg Med Date: 2020-12-09