Annotated Bib 6:

Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of Prehospital Mode of Transport

With Mortality in Penetrating Trauma: A Trauma System–Level Assessment of Private Vehicle

Transportation vs Ground Emergency Medical Services. JAMA Surg. 2018;153(2):107–113.

doi:10.1001/jamasurg.2017.3601

This study intended to find the difference in mortality rates between patients with

penetrating trauma in urban settings who are transported to a Level I/II trauma center via private

transport and EMS transport. The authors used data from the American College of Surgeons

National Trauma Databank (NTDB) regarding pre-hospital and emergency department (ED)

deaths in the 100 most populous trauma systems in the US from 2010-2012. Once various groups

were excluded from the study due to factors such as age, irrelevant transportation methods, and

location, the study analyzed the mortality rates of 103,029 patients who were either transported

via private vehicle or EMS transport. The raw mortality rates and those adjusted for risk and

injury severity were both included in the results of the study. The authors also further broke

down the study into patients who had experienced stab wounds and patients who had gunshot

wounds (GSW). The study ultimately found that the unadjusted mortality was lower in those

patients who were transported via private vehicle ( 2.2%) than those who were transported via

EMS (11.6%). The risk-adjusted mortality rates came to the same conclusion; those who were

transported via private vehicle were less likely to die than those who were transported by EMS

transport. Furthermore, GSW patients who were transported by a private vehicle had a 4.5%

mortality rate, while those who were given EMS transport had a 9.3% mortality rate. Lastly,

patients with stab wounds were also less likely to die if they were transported to a trauma center
with private vehicle transport (0.2%) versus those who were transported via ambulance (2.9%).

These data suggest that a “scoop and run” approach to trauma care would yield a lower mortality

rate than a “stay and play” approach, though the two were not directly compared in this

particular study. The study concludes by saying that though this data is valuable, as it trauma

system-level data that can contribute to the implementation of policies at the system level,

additional research must be done to further investigate the topic.

The authors of this study, Michael W. Wandling, MD, MS; Avery B. Nathens, MD,

Ph.D.; Michael B. Shapiro, MD; Elliott R. Haut, MD, Ph.D., are qualified to discuss the

emergency transport of trauma victims and trauma victim mortality rates due to their impressive

credentials and affiliations. Michael W. Wandling has a Doctor of Medicine and a Master of

Science degree and is affiliated with the Division of Trauma and Critical Care, Department of

Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; the Surgical

Outcomes and Quality Improvement Center, Department of Surgery, Center for Healthcare

Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the

Division of Research and Optimal Patient Care, American College of Surgeons, Chicago,

Illinois. Avery B. Nathens also has a Doctor of Medicine as well as a Ph.D. and is affiliated with

the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago,

Illinois; and the Department of Surgery, Sunnybrook Health Sciences Centre, University of

Toronto, Toronto, Ontario, Canada. Moreover, Micheal B. Shapiro has a Doctor of Medicine and

is affiliated with the Division of Trauma and Critical Care, Department of Surgery, Northwestern

University Feinberg School of Medicine, Chicago, Illinois. Finally, Elliot R. Haut has a Doctor

of Medicine and a Ph.D., and is affiliated with the Division of Acute Care Surgery, Department

of Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland; the Department of
Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore,

Maryland; the Department of Emergency Medicine, The Johns Hopkins School of Medicine,

Baltimore, Maryland; and the Johns Hopkins University School of Public Health, Baltimore,

Maryland. The authors published the source in February of 2018, placing it within the five-year

credibility span that is allocated for science studies and articles and thereby making it a reliable

source. Furthermore, the authors examined all sides of the issue by not only including raw

mortality scores but adjusting them for risk and injury severity so the rate of each injury was

being compared to another injury with the same or similar injury severity and risk. The

information was also broad as well as deep, as the authors not only provided data regarding

general penetrating trauma injuries but also broke down the data into two types of penetrating

trauma and analyzed each group as a separate set of data. The two groups were victims of

gunshot wounds and stab wounds. In the “discussion” portion of the analysis that directly

followed the results, the authors described data from “previous research” that indicates that some

advanced life support prehospital treatment measures, such as endotracheal intubation and

intravenous fluid administration, could potentially increase the pre-hospital mortality rate of the

patient. This information can be corroborated by two studies referenced in the article. The first

one is a study by Liberman M, Mulder D, and Sampalis J entitled “Advanced or basic life

support for trauma: meta-analysis and critical review of the literature”, and the second one is

study written by

Liberman M, Mulder D, Lavoie A, Denis R, and Sampalis JS and is titled “Multicenter Canadian

study of prehospital trauma care.” Finally, the purpose of this study is to incite further research in

the area of prehospital care and transportation of the trauma patient as well as inform those who

wish to pursue a study in the emergency transportation field about the current state of trauma
systems across the U.S. The study is intended primarily for researchers, those who work in the

field of emergency medicine, and those in charge of implementing policies at the trauma-system

level in the hopes that emergency transportation can be altered to decrease prehospital mortality

rates as much as possible.