An analysis of police transport in an Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.

J Trauma Acute Care Surg

From the Department of Surgery, Tulane University School of Medicine (S.T., E.T., C.A., S.N., D.T.), New Orleans, Louisiana; Department of Surgery, Temple University Hospital (Z.M., A.J.G.), Philadelphia, Pennsylvania; Department of Surgery, The Johns Hopkins University School of Medicine (E.R.H., E.E.), Baltimore, Maryland; Department of Surgery, University of Pennsylvania Perelman School of Medicine (S.R., J.K.), Philadelphia, Pennsylvania; Department of Surgery, Mount Sinai Hospital (G.C., M.M.), Chicago, Illinois; Department of Surgery, Cook County Health (L.C.T., P.M.), Chicago, Illinois; Department of Surgery, Loma Linda University Medical Center (S.B., M.R.), Loma Linda, California; Department of Surgery, University of California Davis Medical Center (L.E.C., D.V.S.), Sacramento, California; Department of Surgery, Cooper University Hospital (A.G.-S., A.B.), Camden, New Jersey; Department of Surgery, Grant Medical Center (M.C.S., A.L.), Columbus, Ohio; Department of Surgery, Our Lady of the Lake Regional Medical Center (E.B.), Baton Rouge, Louisiana; Department of Surgery, Allegheny General Hospital (M.R.N., J.B.), Pittsburgh, Pennsylvania; Department of Surgery, Cape Fear Valley Hospital (M.C.N.), Fayetteville, North Carolina; Department of Surgery, Ascension St. Vincent Hospital (L.E.J., J.W.), Indianapolis, Indiana; Department of Surgery, University of Rochester Medical Center (M.V., K.D.), Rochester, New York; Department of Surgery, Sydney & Lois Eskanzi Hospital (Smith Level I Shock Trauma) (T.Z.H., E.H.), Indianapolis, Indiana; Department of Surgery, Research Medical Center (M.J.L.), Kansas City, Missouri; Department of Surgery, Broward Health Medical Center (J.D.B., D.R.M.), Ft Lauderdale, Florida; Department of Surgery, Brigham & Women's Hospital (R.A., B.O.), Boston, Massachusetts; Department of Surgery, Johns Hopkins Bayview Medical Center (R.F., S.L.R.), Baltimore, Maryland; Department of Surgery, University of Kentucky (L.W., A.C.B.), Lexington, Kentucky; Department of Surgery, Ascension Via Christi Hospital St Francis (J.M.H., K.L.L.), Wichita, Kansas; Department of Surgery, University of Texas Health-Tyler (S.H.N., J.M.), Tyler, Texas; Department of Surgery, Medical City Plano (M.A.G., M.M.C.), Plano, Texas; and Tufts Medical Center (N.B., A.T.), Boston, Massachusetts.

Published: August 2022

Background: Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been determined in a multicenter study. We hypothesized that PT would not result in improved outcomes.

Methods: This was a multicenter, prospective, observational study of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. Police transport and ALS patients were allocated via nearest neighbor, propensity matching. Transport mode also examined by Cox regression.

Results: Of 1,618 total patients, 294 (18.2%) had PT and 1,324 (81.8%) were by ALS. After matching, 588 (294/cohort) remained. The patients were primarily Black (n = 497, 84.5%), males (n = 525, 89.3%, injured by gunshot wound (n = 494, 84.0%) with 34.5% (n = 203) having Injury Severity Score of 16 or higher. Overall mortality by propensity matching was not different between cohorts (15.6% ALS vs. 15.0% PT, p = 0.82). In severely injured patients (Injury Severity Score ≥16), mortality did not differ between PT and ALS transport (38.8% vs. 36.0%, respectively; p = 0.68). Cox regression analysis controlled for relevant factors revealed no association with a mortality benefit in patients transported by ALS.

Conclusion: Police transport of penetrating trauma patients in urban locations results in similar outcomes compared with ALS. Immediate transport to definitive trauma care should be emphasized in this patient population.

Level Of Evidence: Prognostic and Epidemiologic; Level III.

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http://dx.doi.org/10.1097/TA.0000000000003563	DOI Listing

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