An Eastern Association for the Surgery of Trauma Multicenter Trial Examining Prehospital Procedures in Penetrating Trauma Patients.

BACKGROUND Pre-hospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHP on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHP would have better outcomes than those undergoing PHP. METHODS This was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHP and transport mechanism on in-hospital mortality were examined. RESULTS Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily black (n=1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n=1,510, 66.0%) with 34.1% (n=726) having New Injury Severity Score (NISS) ≥16. 62.5% (n=1427) were transported by Advanced Life Support (ALS) EMS, 17.2% (n=392) by private vehicle, 13.7 % (n=312) police, and 6.7% (n=153) by Basic Life Support (BLS) EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial ED vitals did not. Receipt of ≥1 PHP increased mortality odds (OR:1.36, 95% CI: 1.01-1.83; P=0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed intubation (OR: 10.76; 95%CI: 4.02 - 28.78, P<0.001), C-spine immobilization (OR:5.80; 95%CI:1.85 - 18.26; P<0.01) and pleural decompression (OR:3.70, 95%CI: 1.33-10.28, P=0.01) had the highest odds of mortality after adjusting for multiple variables. CONCLUSION PHP in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes. LEVEL OF EVIDENCE Prognostic; Level III.