Outcomes of Trauma "Walk-Ins" in the American College of Surgeons Trauma Quality Program Database.
Publication/Presentation Date
5-1-2024
Abstract
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
DISCUSSION: 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.
Volume
90
Issue
5
First Page
1037
Last Page
1044
ISSN
1555-9823
Published In/Presented At
Syamal, S., Tran, A. H., Huang, C. C., Badrinathan, A., Bassiri, A., Ho, V. P., & Towe, C. W. (2024). Outcomes of Trauma "Walk-Ins" in the American College of Surgeons Trauma Quality Program Database. The American surgeon, 90(5), 1037–1044. https://doi.org/10.1177/00031348231220597
Disciplines
Medicine and Health Sciences
PubMedID
38085592
Department(s)
Fellows and Residents
Document Type
Article