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Program

WSU Medical School

Training Level

Medical Student

Institution

Wayne State University

Abstract

Introduction: Current data suggest that trauma patients arriving via private vehicle transport (PVT) have improved outcomes compared to patients arriving via EMS. Additionally, age has been demonstrated to impact patient outcomes in trauma. This study hypothesizes older patients will be more likely to utilize EMS transportation over PVT to the hospital in trauma. Additionally, this study hypothesizes that improved outcomes in PVT will be demonstrated across pediatric, adult, and geriatric age groups. Methods: This study was conducted at an academic, regional, Level 1 Trauma Center in Detroit from 2013-2017. The data were obtained from a trauma registry and chart review. Inclusion criteria were trauma patients presenting to the hospital utilizing PVT that were admitted, died in the emergency department, or transferred out of hospital. Exclusion criteria included patients transferred from outside hospitals. Patients with the same inclusion and exclusion criteria utilizing EMS were the comparison group (N=4997, PVT n= 1782). Patients were further classified as pediatric (age 0-14, n=276), adults (age 15-64, n=3433), and geriatrics (age > 65, n= 1287). To describe statistical significance (p<0.01), chi-square tests were utilized for nominal data, and independent samples t-tests were utilized for continuous data.Results:In total, 35.7% of trauma patients arrived via PVT. The average age for PVT was significantly lower than EMS (45 and 49, respectively). For all age groups, gender, race and insurance status were not significantly different between groups. All age groups were more likely to be transferred out if they arrived by PVT, average GCS was higher and trauma activation level was lower in PVT across age groups. Mechanism of injury was also significantly different between all age groups.56.9% of pediatric patients sustaining trauma arrived by PVT. These patients were less likely to require operation. Injury Severity Score (ISS), vital signs, anatomic location of injury and outcomes including final disposition, complications and mortality were not significant. 33.9% of adults sustaining trauma arrived by PVT. These patients had lower ISS and were less likely to have injuries to critical locations, require intubation, or require admission to the ICU. They were more likely to be tachycardic, normotensive, sustain poly-trauma, and be placed in observation. Adult patients arriving by PVT had lower LOS, total ICU days, mortality, and complications. They were most likely to be discharged to home. 35.7% of geriatric patients sustaining trauma utilized PVT. Findings were similar to adults, except final disposition showed a greater need for discharge with assistance in the geriatric group. Patients arriving by PVT were more likely to be discharged home with home health and patients by EMS were more likely to require placement in a nursing facility. Outcomes measures are similar to adults with the exception of no significant difference in mortality. Conclusions: The average age of patients arriving by EMS was significantly higher, however, the proportion of patients who arrived by PVT was greatest in pediatric patients. As this hospital is not a pediatric trauma center, prehospital triage may account for the significantly lower use of EMS in this age group. Adults did show lower mortality rates in the PVT group; however, this was not replicated in pediatric or geriatric groups. Excluding pediatric patients, other outcome measures including ICU admissions, ventilator days, length of stay and complications were improved in both geriatric and adult patients utilizing PVT. However, these results were not adjusted for confounding variables. As geriatric patients were more likely to need placement in nursing facilities, this may account for the longer LOS compared to adults.

Publication Date

5-2019

The Impact of Age on Outcomes and Mode of Transport in Trauma

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