title: Severity-adjusted mortality in trauma patients transported by police.
abstract: OBJECTIVE
  Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia.
  
  
  METHODS
  This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index.
  
  
  RESULTS
  Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police.
  
  
  CONCLUSIONS
  We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care.
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: roger.band@uphs.upenn.edu.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Band
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rama A
authors.initials: RA
authors.lastname: Salhi
authors.affiliation: Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Powell
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D016495:Police; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data; D014193:Trauma Centers; D014948:Wounds, Gunshot / Q000401:mortality; D014950:Wounds, Penetrating / Q000401:mortality*; D014951:Wounds, Stab / Q000401:mortality