Dr. Pryor was killed in action in Iraq while serving in the United States Army on December 25, 2008. He was instrumental in the development of this idea, the acquisition of the data, and the early versions of the manuscript. He was an extraordinary clinician, researcher, teacher, mentor, and friend and is greatly missed at the University of Pennsylvania and beyond, by his many collaborators, patients, and friends.
Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma
Article first published online: 16 DEC 2010
© 2010 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 1, pages 32–37, January 2011
How to Cite
Band, R. A., Pryor, J. P., Gaieski, D. F., Dickinson, E. T., Cummings, D. and Carr, B. G. (2011), Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma. Academic Emergency Medicine, 18: 32–37. doi: 10.1111/j.1553-2712.2010.00948.x
Presented at the Society for Academic Emergency Medicine annual meeting, New Orleans, LA, May 2009.
The authors have no disclosures or conflicts of interest to report.
Supervising Editor: Robert T. Gerhardt, MD, MPH.
- Issue published online: 10 JAN 2011
- Article first published online: 16 DEC 2010
- Received November 20, 2009; revisions received March 11 and May 24, 2010; accepted June 1, 2010.
ACADEMIC EMERGENCY MEDICINE 2011; 18:32–37 © 2011 by the Society for Academic Emergency Medicine
Background: More than a decade ago, the city of Philadelphia began allowing police transport of penetrating trauma patients.
Objectives: The objective was to determine the relation between prehospital mode of transport (police department [PD] vs. Philadelphia Fire Department (PFD) emergency medical services [EMS]) and survival in subjects with proximal penetrating trauma.
Methods: The authors performed a retrospective cohort study of prospectively collected trauma registry data. All subjects who sustained proximal penetrating trauma and who presented to a Level I urban trauma center over a 5-year period (January 1, 2003, to December 31, 2007) were included. Mortality for subjects presenting by EMS was compared to that of those who arrived by PD transport in unadjusted and adjusted analyses. Unadjusted analyses were performed using the chi-square test, Wilcoxon rank sum test, and Student’s t-test. Adjusted analyses were performed using logistic regression using the Trauma Injury Severity Score (TRISS) methodology. Data are presented as percentages, odds ratios (ORs), and 95% confidence intervals (CIs). Total hospital length of stay was examined as a secondary outcome.
Results: Of the 2,127 subjects, 26.8% were transported to the emergency department (ED) by PD, and 73.2% by EMS. The mean (± standard deviation [SD]) age of PD subjects was 26.3 (±9.1) years and 92% were male versus EMS subjects whose mean (±SD) age was 31.5 (±11.8) years and of whom 87% were male. Overall, 70.8% sustained a gunshot wound (GSW), and 29.2% sustained a stab wound (SW). Overall Injury Severity Score (ISS) was 11.21 (ISS for PD, 14.2 ± 17.5; for EMS, 10.1 ± 14.5; p < 0.001), and 16.6% of the subjects died (PD, 21.4 ± 0.41%; EMS, 14.8 ± 0.36%; p < 0.001). In unadjusted analyses, PD subjects were more likely to die than EMS subjects (OR = 1.6, 95% CI = 1.2 to 2.0; p < 0.001). When adjusting for injury severity using TRISS, there was no difference in survival between PD and EMS subjects (OR = 1.01, 95% CI = 0.63 to 1.61). Median length of hospital stay was 1 day and did not differ according to mode of prehospital transport (p = 0.159).
Conclusions: Although unadjusted mortality appears to be higher in PD subjects, these findings are explained by the more severely injured population transported by PD. The current practice of permitting police officers to transport penetrating trauma patients should be continued.