Department of Surgery, The MetroHealth System and Case Western Reserve University, Cleveland, OH, USA.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Am Surg. 2024 May;90(5):1037-1044. doi: 10.1177/00031348231220597. Epub 2023 Dec 12.
Outcomes of trauma "walk-in" patients (using private vehicles or on foot) are understudied. We compared outcomes of ground ambulance vs walk-ins, hypothesizing that delayed resuscitation and uncoordinated care may worsen walk-in outcomes.
A retrospective analysis 2020 American College of Surgeons Trauma Quality Programs (ACS-TQP) databases compared outcomes between ambulance vs "walk-ins." The primary outcome was in-hospital mortality, excluding external facility transfers and air transports. Data was analyzed with descriptive statistics, bivariate, multivariable logistic regression, including an Inverse Probability Weighted Regression Adjustment with adjustments for injury severity and vital signs. The primary outcome for the 2019 (pre-COVID-19 pandemic) data was similarly analyzed.
In 2020, 707,899 patients were analyzed, 556,361 (78.59%) used ambulance, and 151,538 (21.41%) were walk-ins. We observed differences in demographics, hospital attributes, medical comorbidities, and injury mechanism. Ambulance patients had more chronic conditions and severe injuries. Walk-ins had lower in-hospital mortality (850 (.56%) vs 23,131 (4.16%)) and arrived with better vital signs. Multivariable logistic regression models (inverse probability weighting for regression adjustment), adjusting for injury severity, demographics, injury mechanism, and vital signs, confirmed that walk-in status had lower odds of mortality. For the 2019 (pre-COVID-19 pandemic) database, walk-ins also had lower in-hospital mortality.
Our results demonstrate better survival rates for walk-ins before and during COVID-19 pandemic. Despite limitations of patient selection bias, this study highlights the need for further research into transportation modes, geographic and socioeconomic factors affecting patient transport, and tailoring management strategies based on their mode of arrival.
创伤“步行”患者（使用私人车辆或步行）的预后研究较少。我们比较了地面救护车和步行患者的结局，假设延迟复苏和不协调的护理可能会使步行患者的结局恶化。
回顾性分析 2020 年美国外科医师学院创伤质量计划（ACS-TQP）数据库，比较了救护车和“步行者”之间的结果。主要结局是院内死亡率，不包括外部医疗机构转移和空中转运。使用描述性统计、双变量、多变量逻辑回归进行数据分析，包括使用逆概率加权回归调整，根据损伤严重程度和生命体征进行调整。2019 年（COVID-19 大流行前）的数据也进行了类似的主要结局分析。
2020 年，共分析了 707899 例患者，其中 556361 例（78.59%）使用救护车，151538 例（21.41%）为步行者。我们观察到在人口统计学、医院属性、医疗合并症和损伤机制方面存在差异。救护车患者有更多的慢性疾病和严重损伤。步行者的院内死亡率较低（850（0.56%）比 23131（4.16%）），且到达时生命体征较好。多变量逻辑回归模型（逆概率加权回归调整），调整损伤严重程度、人口统计学、损伤机制和生命体征，证实了步行者状态的死亡率较低。对于 2019 年（COVID-19 大流行前）数据库，步行者的院内死亡率也较低。
我们的结果表明，在 COVID-19 大流行前后，步行者的生存率更高。尽管存在患者选择偏倚的局限性，但本研究强调需要进一步研究影响患者转运的交通方式、地理和社会经济因素，以及根据其到达方式制定管理策略。
