title: The forgotten trauma patient: outcomes for injured patients evaluated by emergency medical services but not transported to the hospital.
abstract: BACKGROUND
  Injured patients who are not transported by an ambulance to the hospital are often not included in trauma registries. The outcomes of these patients have until now been unknown. Understanding what happens to nontransports is necessary to better understand triage validity, patient outcomes, and costs associated with injury. We hypothesized that a subset of patients who were not transported from the scene would later present for evaluation and that these patients would have a nonzero mortality rate.
  
  
  METHODS
  This is a population-based, retrospective cohort study of injured adults and children for three counties in California from 2006 to 2008. Prehospital data for injured patients for whom an ambulance was dispatched were probabilistically linked to trauma registry data from four trauma centers, state-level discharge data, emergency department records, and death files (1-year mortality).
  
  
  RESULTS
  A total of 69,413 injured persons who were evaluated at the scene by emergency medical services were included in the analysis. Of them, 5,865 (8.5%) were not transported. Of those not transported, 1,616 (28%) were later seen in an emergency department and discharged and 92 (2%) were admitted. Seven (0.2%) patients later died.
  
  
  CONCLUSIONS
  Patients evaluated by emergency medical services, but not initially transported from the field after injury, often present later to the hospital. The mortality rate in this population was not zero, and these patients may represent preventable deaths.
  
  
  METHODS
  III, therapeutic study.
authors.affiliation: Stanford University School of Medicine, Stanford, California 94305-5641, USA. kristans@stanford.edu
authors.forename: Kristan
authors.initials: K
authors.lastname: Staudenmayer
authors.forename: Renee
authors.initials: R
authors.lastname: Hsia
authors.forename: Ewen
authors.initials: E
authors.lastname: Wang
authors.forename: Karl
authors.initials: K
authors.lastname: Sporer
authors.forename: David
authors.initials: D
authors.lastname: Ghilarducci
authors.forename: David
authors.initials: D
authors.lastname: Spain
authors.forename: Robert
authors.initials: R
authors.lastname: Mackersie
authors.forename: John
authors.initials: J
authors.lastname: Sherck
authors.forename: Richard
authors.initials: R
authors.lastname: Kline
authors.forename: Craig
authors.initials: C
authors.lastname: Newgard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult