Does Mode of Transport Affect Outcomes in Trauma Patients? Data from an Urban Trauma Center

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Introduction: Trauma systems are designed to rapidly transport patients to their highest level of care by the Emergency Medical Services (EMS). Transport time to a trauma center (TC) may be a variable in decreasing the first and second peaks in trimodal trauma death. We postulated that early transport by Private Vehicle (PV) may improve trauma mortality. Methods: Data from the trauma registry of an urban ACS verified Level 1 TC from January 1, 2017 to December 31, 2021 was studied for patients that received the highest level of trauma activation. Demographic data, injury characteristics, Injury Severity Score (ISS), Revised Trauma Score (RTS) and mortality was compared between patients transported by EMS and PV. Logistic regression analysis was used to analyze the data. Results: There were 1157 and 536 highest level activations in the EMS and PV groups respectively. The PV patients were younger, more likely to have gun-shot wounds to the torso, and had lower mean ISS and RTS scores (all p < 0.001). Patients arriving by PV also had lower risk of mortality overall (OR = 0.30, p < 0.001). After controlling for group differences in a multiple regression model, the difference in the risk of mortality was no longer statistically significant (OR = 0.85, p = 0.637). Conclusion: Time to TC may be a more important variable in trauma outcomes. EMS scoop and run triage may be superior to on-field resuscitation. Once a patient arrives at a TC, outcomes are the same regardless of mode of transport.

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