Ambulance transport is associated with a higher mortality than private transport following major penetrating trauma in a semi-urban environment

Aims

The use of private transportation has been associated with improved outcomes in urban trauma patients. The need for patient stabilization at the scene needs to be balanced with the need for early operative intervention, and therefore the need for rapid transportation to hospital. Our aim was to assess the relationship between the mode of transport to hospital and outcome in a semi-urban trauma environment.

Methods

Data were collected prospectively on 1,396 patients admitted to a Level 1 South African trauma unit over a 1-year period. The Revised Trauma Score was used to assess injury severity and physiological derangement at the time of admission, and to allow comparison between the groups. Mortality was defined as death within 30 days.

Results

The mortality in the blunt trauma patients (n = 527) was higher in the ambulance transport group, but this was not statistically significant. However, the mortality in the penetrating trauma patients (n = 808) was significantly higher in the ambulance transport group (P = 0.020, chi-square; Table 1) despite similar Revised Trauma Scores (Table 1).

Table 1 (abstract P442)

Conclusion

The use of ambulance transportation is associated with a 3.7-fold increase in mortality following penetrating injury. This may be related to longer times in the field resulting in delay to definitive care in hospital.