Effect of private versus emergency medical systems transportation in trauma patients in a mostly physician based system- a retrospective multicenter study based on the TraumaRegister DGU®.
BACKGROUND
The effects of private transportation (PT) to definitive trauma care in comparison to transportation using Emergency Medical Services (EMS) have so far been addressed by a few studies, with some of them finding a beneficial effect on survival. The aim of the current study was to investigate epidemiology, pre- and in-hospital times as well as outcomes in patients after PT as compared to EMS recorded in the TraumaRegister DGU®.


METHODS
All patients in the database of the TraumaRegister DGU® (TR-DGU) from participating European trauma centers treated in 2009 to 2013 with available data on the mode of transportation, ISS ≥ 4 and ICU treatment were included in the study. Epidemiological data, pre- and in-hospital times were analysed. Outcomes were analysed after adjustment for RISC-II scores.


RESULTS
76,512 patients were included in the study, of which 1,085 (1.4 %) were private transports. Distribution of ages and trauma mechanisms showed a markedly different pattern following PT, with more children < 15 years treated following PT (3.3 % EMS vs. 9.6 for PT) and more elderly patients of 65 years or older (26.6 vs 32.4 %). Private transportation to trauma care was by far more frequent in Level 2 and 3 hospitals (41.2 % in EMS group vs 73.7 %). Median pre-hospital times were also reduced following PT (59 min for EMS vs. 46 for PT). In-hospital time in the trauma room (66 for EMS vs. 103 min for PT) and time to diagnostics were prolonged following PT. Outcome analysis after adjustment for RISC-II scores showed a survival benefit of PT over EMS transport (SMR for EMS 1.07 95 % CI 1.05-1.09; for PT 0.85 95 % CI 0.62-1.08).


CONCLUSIONS
The current study shows a distinct pattern concerning epidemiology and mechanism of injury following PT. PT accelerates the median pre-hospital times, but prolongs time to diagnostic measures and time in the trauma room.


CONCLUSIONS
In this distinct collective, PT seemed to lead to a small benefit in terms of mortality, which may reflect pre-hospital times, pre-hospital interventions or other confounders.
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany. stephan.huber@mri.tum.de.
Stephan
S
Huber
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Moritz
M
Crönlein
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Francesca
F
von Matthey
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Marc
M
Hanschen
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Fritz
F
Seidl
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Chlodwig
C
Kirchhoff
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Peter
P
Biberthaler
IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
Rolf
R
Lefering
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich - TUM, Ismaninger Str. 22, D-81675, Munich, Germany.
Stefan
S
Huber-Wagner
D000368:Aged; D000552:Ambulances; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods*; D014193:Trauma Centers / Q000706:statistics & numerical data*
Emergency department; Emergency services; Polytrauma; Private transport