Stop the Bleed: Now Wait for EMS or Get in the Car and Drive? A Secondary Analysis of an Eastern Association for the Surgery of Trauma Multicenter Trial

Abstract

INTRODUCTION: The Stop the Bleed campaign asks that bystanders take an active role in controlling hemorrhage after trauma. However, whether extending the bystanders’ duty to perform private vehicle transport (PVT) results in improved survival is unknown. We hypothesized that in urban penetrating trauma, where prehospital procedures have shown to be harmful, PVT would result in improved outcomes compared with advanced life support (ALS) transport. METHODS: Post hoc analysis of an EAST multicenter, prospective observational trial was performed on adult patients with penetrating torso or extremity trauma at 25 urban trauma centers. Patients were allocated to PVT or ALS using nearest neighbor propensity score matching. Wilcoxon signed-rank or McNemar test and logistic regression were performed for univariate and multivariate analyses. RESULTS: Of 1,830 total patients, 397 (21.7%) had PVT, and 1,433 (78.3%) had ALS transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. Patients were primarily male (n = 702, 90.2%), Black (n = 537, 69%), and injured by gunshot wounds (n = 497, 63.9%). ALS transport had significantly higher emergency department (4.8% vs 1.9%, p = 0.02) and overall mortality (5.4% vs 2.8%, p = 0.02). Logistic regression demonstrated PVT was associated with survival (odds ratio 0.30, 95% CI 0.10 to 0.84, p = 0.02). Variables associated with mortality included increasing Injury Severity Score and thoracic injuries (Table 1). Complications did not differ between groups. Table 1. - Logistic Regression Analysis of Patient and Injury Factors on Mortality Parameter Odds Ratio 95% CI p Value Age, y 1.02 0.98–1.05 0.40 Male 2.95 0.31–27.8 0.34 Injury Severity Score 1.10 1.07–1.13 0.001 Private vehicle transport 0.30 0.10–0.84 0.02 Thoracic injury 8.39 2.64–36.6 0.001 Abdomen injury 2.10 0.80–5.52 0.13 Pelvis injury 0.92 0.18–4.76 0.92 Extremity injury 1.18 0.47–2.97 0.72 CONCLUSION: Immediate PVT in lieu of prehospital procedures (by ALS) may improve outcomes in urban penetrating trauma. Bystander education incorporating PVT in this specific patient population could save lives.