Importance Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes.

Objective To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems.

Design, Setting, and Participants Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle.

Main Outcome and Measure In-hospital mortality.

Results Of the 2 329 446 records assessed for eligibility, 103 029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR, 0.45; 95% CI, 0.36-0.56) and stab wound (OR, 0.32; 95% CI, 0.20-0.52) subgroups.

Conclusions and Relevance Private vehicle transport is associated with a significantly lower likelihood of death when compared with ground EMS transport for individuals with gunshot wounds and stab wounds in urban US trauma systems. System-level evidence such as this can be a valuable tool for those responsible for developing and implementing policies at the trauma system level.

重要性 受伤后进行最终护理的时间对创伤患者的预后很重要。院前创伤护理是根据个体创伤系统制定的政策提供的，是受伤患者护理的重要组成部分。由于缺乏系统级的创伤研究，整个创伤系统的院前护理政策存在相当大的差异，可能会影响患者的预后。

目的 评估私家车院前运输是否比地面紧急医疗服务 (EMS) 运输在城市创伤系统中穿透性损伤后具有生存优势。

设计、设置和参与者 对 2010 年 1 月 1 日至 2012 年 12 月 31 日国家创伤数据库中的数据进行回顾性队列研究，包括 298 个向国家创伤数据库提供数据的 1 级和 2 级创伤中心位于美国人口最多的 100 个大都市区。在评估合格的 2,329,446 名患者中，有 103,029 名被纳入本研究。所有患者均年满 16 岁，有枪伤或刺伤，由地面 EMS 或私家车运送。

主要结果和测量 住院死亡率。

结果 在评估合格的 2,329,446 条记录中，分析包括 298 个城市 1 级和 2 级创伤中心的 103,029 人。研究人群主要为男性（87.6%），平均年龄为 32.3 岁。其中，黑人占 47.9%，白人占 26.3%，西班牙裔占 18.4%。风险调整后，由私家车运送的穿透伤患者死亡的可能性低于由地面 EMS 运送的患者（优势比 [OR]，0.38；95% CI，0.31-0.47）。这种关联在枪伤（OR，0.45；95% CI，0.36-0.56）和刺伤（OR，0.32；95% CI，0.20-0.52）亚组的分层分析中仍然具有统计学意义。

结论和相关性 对于美国城市创伤系统中枪伤和刺伤的个人，与地面 EMS 运输相比，私家车运输的死亡可能性显着降低。对于那些负责在创伤系统层面制定和实施政策的人来说，诸如此类的系统级证据可能是一个有价值的工具。