Impact of Mode of Arrival to Hospital on Early Mortality in Adults With Penetrating Trauma: A Systematic Review, Meta-Analysis, and Narrative Synthesis.

Background: Penetrating injury is a time-critical disease where early definitive treatment is lifesaving. Although most patients with penetrating trauma reach the emergency department (ED) via emergency medical services (EMS), self-presentation or transport with police are also common. This review synthesizes the available evidence in adult penetrating trauma to evaluate if the mode of transport to hospital impacts early mortality.

Methods: Two groups were defined as follows: transport to hospital with emergency medical services (EMS) and 'other' transport (private or police). Medline, Embase, and CENTRAL databases were searched as well as gray literature. Results were screened by two authors. Eligible studies were assessed for quality and risk of bias and included in both a meta-analysis using a random effects calculation of odds ratio and narrative analysis.

Results: 19 studies were included overall. Meta-analysis using data from nine studies showed EMS transport did not significantly impact early mortality (OR 1.32 [95% CI 0.70-2.48] (p = 0.39)). Overall injury-severity adjusted mortality was assessed using data from 14 studies and was also not significantly affected by EMS transport (OR 1.21 [95% CI 0.93-1.59] (p = 0.16)). Data comparing injury-to-hospital arrival times for medical and nonmedical transport were limited but suggested nonmedical transport was faster amongst an urban cohort of patients.

Conclusions: There was no survival benefit associated with EMS transport among this largely USA-based urban cohort of patients with penetrating trauma. Shorter injury-to-hospital arrival times associated with nonmedical transport may, in some cases, outweigh the benefits of prehospital care. These findings support an emphasis on shortening the prehospital phase for severely injured penetrating trauma patients, which may include use of nonmedical transport where transport times are short.