Mode of transport and prehospital interventions in urban penetrating trauma: A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.
The journal of trauma and acute care surgery · 2025-09-19 · Meta-analysis
Abstract
BACKGROUND: Prehospital procedures in urban penetrating trauma (UPT) are controversial. In certain locales, modes of immediate transport, such as police and private vehicle transport, are used with varying frequencies. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether UPT patients should receive police or private vehicle transport over waiting for emergency medical services (EMS) transport. METHODS: Published literature was searched through MEDLINE (via PubMed), Embase (via Elsevier), Web of Science (via Clarivate), and CINAHL Complete (via EBSCO) databases by a professional librarian. The date ranges for our literature search were January 1900 to July 2023. A systematic review and meta-analysis of currently available evidence were performed using the Grading of Recommendations Assessment, Development and Evaluation methodology. RESULTS: A total of six relevant studies were analyzed for police transport, with all being retrospective or prospective, observational studies. The pooled data found that EMS transport did not improve survival to admission (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.83-1.35) or discharge (OR, 1.06; 95% CI, 0.84-1.35) over police transport. A total of two relevant studies were analyzed for private vehicle transport, with both being retrospective studies. The pooled data found that private vehicle transport improved survival (OR, 0.31; 95% CI, 0.11-0.85) to admission over waiting for EMS transport. CONCLUSION: In UPT patients, we conditionally recommend police or private vehicle transport over waiting for EMS transport as adjuncts to traditional prehospital care. STUDY TYPE: Systemic Review and Meta-analysis; Level III.