False reassurances: Mortality risks in penetrating trauma patients with verbal GCS ≥3

On univariable analysis, the following variables were identified as significant risk factors for mortality: non-EMS transport, requiring >10 units of packed red blood cells (PRBC) in the operating room, greater than or equal to two body cavities injured, patients with intrathoracic injury requiring operative intervention on the chest, EDT in trauma bay, two or more trauma bay procedures, need for damage control surgery, two or more body cavities requiring exploration, receiving 20 or more units of blood products in the first 24 hours, and longer operating room time (all p < 0.05). Many systemic changes have been advocated to minimize the time to operative intervention, including direct-to-OR admission and various means of rapid transport. 4 , 5 Unlike other major cities, trauma centers in Philadelphia receive nearly 80% of all penetrating trauma patients via local police transport, as they are often first on the scene and able to transport the patient to the nearest trauma center faster than EMS providers. 6 This factor (i.e. method of patient transport) is an important variable to consider, especially as prior Philadelphia-based research has found that police-transported patients have similar in-hospital mortality as patients transported via EMS, despite patients in the former group being more severely injured. 6 Additionally, changes in resuscitation practices—including damage control resuscitation, whole blood, tranexamic acid, and vasopressin administration—can decrease the overall blood product need and improve mortality. 7 , 8 We recognize that this study has several limitations. [...]the data was extracted from the medical record and required the research team to review operative reports. Since the research team may not have been the treating physicians, there could be misinterpretations of these documents.