Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Scand J Trauma Resusc Emerg Med. 2023 Sep 8;31(1):45. doi: 10.1186/s13049-023-01112-x.
Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome.
This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality.
A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS.
Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.
瑞典正面临枪支暴力的激增，这需要优化院前转运方法，对当前实践进行调查对于这种优化至关重要。严重穿透性创伤的管理时间敏感，限制院前干预可能会有生存获益。一个重要方面是警察或私人车辆不受监管地将患者运往医院，这可能会缩短时间，但也可能与不良后果相关。目前尚不清楚在瑞典是否有穿透性创伤患者的转运超出了紧急医疗服务（EMS）的范围，以及这是否会影响结果。
这是一项回顾性、全国性研究，纳入了 2011 年 6 月 13 日至 2019 年 12 月 31 日期间在瑞典国家创伤登记处（SweTrau）登记的所有穿透性创伤和损伤严重程度评分（ISS）≥15 的患者。我们假设会发生警察和私人车辆的转运，并且这会影响死亡率。
共纳入 657 名患者。EMS 转运了 612 名患者（93.2%），警察转运了 10 名患者（1.5%），私人车辆转运了 27 名患者（4.1%）。与私人车辆（59%，n=16）和 EMS（32%，n=198）相比，警察转运的枪伤（GSW）更常见，占 80%（n=8）。在急诊科（ED），警察转运患者的格拉斯哥昏迷评分（GCS）较低，为 11.5（四分位距[IQR] 3，15），与 EMS（15，IQR 14，15）和私人车辆（15，IQR 12.5，15）相比。EMS 的 30 天死亡率为 30%（n=184），警察转运的死亡率为 50%（n=5），私人车辆转运的死亡率为 22%（n=6）。与 EMS 相比，私人车辆转运的比值比（OR）为 0.65（95%CI 0.24，1.55，p=0.4），警察转运的 OR 为 2.28（95%CI 0.63，8.3，p=0.2），与死亡率增加无关。
确实发生了非 EMS 转运，但发生率较低，且不会影响死亡率。警察转运的 GSW 更常见，且患者到达 ED 时的 GCS 评分较低，这需要进一步调查瑞典枪击伤患者的运作管理。
