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Harrell KN, Grimes AD, Gill H, Reynolds JK, Ueland WR, Sciarretta JD, Todd SR, Trust MD, Ngoue M, Thomas BW, Ayuso SA, LaRiccia A, Spalding MC, Collins MJ, Collier BR, Karam BS, de Moya MA, Lieser MJ, Chipko JM, Haan JM, Lightwine KL, Cullinane DC, Falank CR, Phillips RC, Kemp MT, Alam HB, Udekwu PO, Sanin GD, Hildreth AN, Biffl WL, Schaffer KB, Marshall G, Muttalib O, Nahmias J, Shahi N, Moulton SL, Maxwell RA. A western trauma association multicenter comparison of mesh versus non-mesh repair of blunt traumatic abdominal wall hernias. Injury 2024; 55:111204. [PMID: 38039636 DOI: 10.1016/j.injury.2023.111204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Blunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical site infections (SSI) and not improve hernia recurrence. MATERIALS AND METHODS A secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012-12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI. RESULTS 157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model. CONCLUSION Mesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.
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Affiliation(s)
- Kevin N Harrell
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, United States.
| | | | - Harkanwar Gill
- University of Oklahoma, Oklahoma City, OK, United States
| | | | - Walker R Ueland
- University of Kentucky School of Medicine, Lexington, KY, United States
| | | | | | - Marc D Trust
- University of Texas at Austin, Austin, TX, United States
| | - Marielle Ngoue
- University of Texas at Austin, Austin, TX, United States
| | - Bradley W Thomas
- Atrium Health Carolinas Medical Center, Charlotte, NC, United States
| | - Sullivan A Ayuso
- Atrium Health Carolinas Medical Center, Charlotte, NC, United States
| | | | | | | | | | - Basil S Karam
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marc A de Moya
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mark J Lieser
- Research Medical Center, Kansas City, MO, United States
| | - John M Chipko
- Research Medical Center, Kansas City, MO, United States
| | - James M Haan
- Ascension Via Christi on St. Francis Hospital, Wichita, KS, United States
| | - Kelly L Lightwine
- Ascension Via Christi on St. Francis Hospital, Wichita, KS, United States
| | | | | | | | | | - Hasan B Alam
- University of Michigan, Ann Arbor, MI, United States
| | | | - Gloria D Sanin
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Amy N Hildreth
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, La Jolla, CA, United States
| | | | - Gary Marshall
- Medical City Plano Hospital, Plano, TX, United States
| | - Omaer Muttalib
- University of California, Irvine, Orange, CA, United States
| | - Jeffry Nahmias
- University of California, Irvine, Orange, CA, United States
| | - Niti Shahi
- Children's Hospital Colorado, Denver, CO, United States
| | | | - Robert A Maxwell
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, United States
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Harrell KN, Grimes AD, Gill H, Reynolds JK, Ueland WR, Sciarretta JD, Todd SR, Trust MD, Ngoue M, Thomas BW, Ayuso SA, LaRiccia A, Spalding MC, Collins MJ, Collier BR, Karam BS, de Moya MA, Lieser MJ, Chipko JM, Haan JM, Lightwine KL, Cullinane DC, Falank CR, Phillips RC, Kemp MT, Alam HB, Udekwu PO, Sanin GD, Hildreth AN, Biffl WL, Schaffer KB, Marshall G, Muttalib O, Nahmias J, Shahi N, Moulton SL, Maxwell RA. Risk factors for recurrence in blunt traumatic abdominal wall hernias: A secondary analysis of a Western Trauma association multicenter study. Am J Surg 2022; 225:1069-1073. [PMID: 36509587 DOI: 10.1016/j.amjsurg.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few studies have investigated risk factors for recurrence of blunt traumatic abdominal wall hernias (TAWH). METHODS Twenty trauma centers identified repaired TAWH from January 2012 to December 2018. Logistic regression was used to investigate risk factors for recurrence. RESULTS TAWH were repaired in 175 patients with 21 (12.0%) known recurrences. No difference was found in location, defect size, or median time to repair between the recurrence and non-recurrence groups. Mesh use was not protective of recurrence. Female sex, injury severity score (ISS), emergency laparotomy (EL), and bowel resection were associated with hernia recurrence. Bowel resection remained significant in a multivariable model. CONCLUSION Female sex, ISS, EL, and bowel resection were identified as risk factors for hernia recurrence. Mesh use and time to repair were not associated with recurrence. Surgeons should be mindful of these risk factors but could attempt acute repair in the setting of appropriate physiologic parameters.
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Affiliation(s)
- Kevin N Harrell
- University of Tennessee College of Medicine Chattanooga, 979 E 3rd Street Suite B 401, Chattanooga, TN, 37403, USA.
| | - Arthur D Grimes
- University of Oklahoma, 800 Stanton L. Young Blvd #9000, Oklahoma City, OK, 73104, USA.
| | - Harkanwar Gill
- University of Oklahoma, 800 Stanton L. Young Blvd #9000, Oklahoma City, OK, 73104, USA.
| | - Jessica K Reynolds
- University of Kentucky School of Medicine, 800 Rose St, MN268A, Lexington, KY, 40536, USA.
| | - Walker R Ueland
- University of Kentucky School of Medicine, 800 Rose St, MN268A, Lexington, KY, 40536, USA.
| | - Jason D Sciarretta
- Grady Health System, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Samual R Todd
- Grady Health System, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Marc D Trust
- University of Texas at Austin, 1501 Red River St, Austin, TX, 78712, USA.
| | - Marielle Ngoue
- University of Texas at Austin, 1501 Red River St, Austin, TX, 78712, USA.
| | - Bradley W Thomas
- Atrium Health Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Sullivan A Ayuso
- Atrium Health Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Aimee LaRiccia
- Grant Medical Center, 111 S Grant Ave, Columbus, OH, 43215, USA.
| | | | | | - Bryan R Collier
- Carilion Clinic, 1906 Belleview Ave SE, Roanoke, VA, 24014, USA.
| | - Basil S Karam
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Marc A de Moya
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Mark J Lieser
- Research Medical Center, 2316 E Meyer Blvd, Kansas City, MO, 64132, USA.
| | - John M Chipko
- Research Medical Center, 2316 E Meyer Blvd, Kansas City, MO, 64132, USA.
| | - James M Haan
- Ascension Via Christi on St. Francis Hospital, 929 St Francis, Wichita, KS, 67214, USA.
| | - Kelly L Lightwine
- Ascension Via Christi on St. Francis Hospital, 929 St Francis, Wichita, KS, 67214, USA.
| | | | | | - Ryan C Phillips
- Denver Health Medical Center, 777 Bannock St, Denver, CO, 80204, USA.
| | - Michael T Kemp
- University of Michigan, 1500 E Medical Center Dr Ann Arbor, MI, 48109, USA.
| | - Hasan B Alam
- University of Michigan, 1500 E Medical Center Dr Ann Arbor, MI, 48109, USA.
| | | | - Gloria D Sanin
- Wake Forest School of Medicine, 1 Medical Center Blvd Winston-Salem, NC, 27157, USA.
| | - Amy N Hildreth
- Wake Forest School of Medicine, 1 Medical Center Blvd Winston-Salem, NC, 27157, USA.
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, La Jolla, CA, 92037, USA.
| | - Kathryn B Schaffer
- Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, La Jolla, CA, 92037, USA.
| | - Gary Marshall
- Medical City Plano Hospital, 3901 W 15th St, Plano, TX, 75075, USA.
| | - Omaer Muttalib
- University of California, Irvine, 101 The City Dr S Orange, CA, 92868, USA.
| | - Jeffry Nahmias
- University of California, Irvine, 101 The City Dr S Orange, CA, 92868, USA.
| | - Niti Shahi
- Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, USA.
| | - Steven L Moulton
- Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, USA.
| | - Robert A Maxwell
- University of Tennessee College of Medicine Chattanooga, 979 E 3rd Street Suite B 401, Chattanooga, TN, 37403, USA.
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Yorkgitis BK, Tatum DM, Taghavi S, Schroeppel TJ, Noorbakhsh MR, Philps FH, Bugaev N, Mukherjee K, Bellora M, Ong AW, Ratnasekera A, Nordham KD, Carrick MM, Haan JM, Lightwine KL, Lottenberg L, Borrego R, Cullinane DC, Berne JD, Rodriguez Mederos D, Hayward TZ, Kerwin AJ, Crandall M. Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients. J Trauma Acute Care Surg 2022; 92:88-92. [PMID: 34570064 DOI: 10.1097/ta.0000000000003421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would not improve mortality in severe traumatic brain injury (TBI) patients. METHODS An Eastern Association for the Surgery of Trauma-sponsored prospective, multicentered, observational study of 15 trauma centers was performed. Patient demographics, injury burden, comorbidities, AT agents, and reversal attempts were collected. Outcomes of interest were head injury severity and in-hospital mortality. RESULTS Analysis was performed on 2,793 patients. The majority of patients were on aspirin (acetylsalicylic acid [ASA], 46.1%). Patients on a platelet chemoreceptor blocker (P2Y12) had the highest mean Injury Severity Score (9.1 ± 8.1). Patients taking P2Y12 inhibitors ± ASA, and ASA-warfarin had the highest head Abbreviated Injury Scale (AIS) mean (1.2 ± 1.6). On risk-adjusted analysis, warfarin-ASA was associated with a higher head AIS (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.34-4.42) after controlling for Injury Severity Score, Charlson Comorbidity Index, initial Glasgow Coma Scale score, and initial systolic blood pressure. Among patients with severe TBI (head AIS score, ≥3) on antiplatelet therapy, reversal with desmopressin (DDAVP) and/or platelet transfusion did not improve survival (82.9% reversal vs. 90.4% none, p = 0.30). In severe TBI patients taking Xa inhibitors who received prothrombin complex concentrate, survival was not improved (84.6% reversal vs. 84.6% none, p = 0.68). With risk adjustment as described previously, mortality was not improved with reversal attempts (antiplatelet agents: OR 0.83; 85% CI, 0.12-5.9 [p = 0.85]; Xa inhibitors: OR, 0.76; 95% CI, 0.12-4.64; p = 0.77). CONCLUSION Reversal attempts appear to confer no mortality benefit in severe TBI patients on antiplatelet agents or Xa inhibitors. Combination therapy was associated with severity of head injury among patients taking preinjury AT therapy, with ASA-warfarin possessing the greatest risk. LEVEL OF EVIDENCE Prognostic, level II.
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Affiliation(s)
- Brian K Yorkgitis
- From the Department of Surgery (B.K.Y., M.C., A.J.K.), University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; Trauma Division (D.M.T.), Our Lady of the Lake RMC, Baton Rouge, Louisiana; Department of Surgery (S.T.), Tulane School of Medicine, New Orleans, Louisiana; Department of Surgery (T.J.S.), UC Health Memorial Hospital, Colorado Springs, Colorado; Department of Surgery (M.R.N., F.H.P.), Allegheny Health Network, Pittsburgh, Pennsylvania; Division of Trauma/Acute Care Surgery (N.B.), Tufts Medical Center, Boston, Massachusetts; Department of Surgery (K.M., M.B.), Loma Linda University Medical Center, Loma Linda, California; Department of Surgery (A.W.O.), Reading Hospital Tower Health, Reading, Pennsylvania; Department of Surgery (A.R.), Crozer Keystone Health System, Upland, Pennsylvania; Tulane University Medical School (K.D.N.), New Orleans, Louisiana; Department of Surgery (M.M.C.), Medical City Plano, Plano, Texas; Department of Surgery (J.M.H., K.L.L.), Via Christi Hospitals Wichita, Wichita, Kansas; Department of Surgery (L.L., R.B.), St. Mary's Medical Center, West Palm Beach, Florida; Department of Surgery (D.C.C.), Maine Medical Center, Portland, Maine; Department of Surgery (J.D.B., D.R.M.), Broward Health Medical Center, Fort Lauderdale, Florida; Department of Surgery (T.Z.H.), Indiana University School of Medicine, Eskenazi Health, Indianapolis, Indiana
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Harrell KN, Grimes AD, Albrecht RM, Reynolds JK, Ueland WR, Sciarretta JD, Todd SR, Trust MD, Ngoue M, Thomas BW, Ayuso SA, LaRiccia A, Spalding MC, Collins MJ, Collier BR, Karam BS, de Moya MA, Lieser MJ, Chipko JM, Haan JM, Lightwine KL, Cullinane DC, Falank CR, Phillips RC, Kemp MT, Alam HB, Udekwu PO, Sanin GD, Hildreth AN, Biffl WL, Schaffer KB, Marshall G, Muttalib O, Nahmias J, Shahi N, Moulton SL, Maxwell RA. Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study. J Trauma Acute Care Surg 2021; 91:834-840. [PMID: 34695060 DOI: 10.1097/ta.0000000000003250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management. METHODS A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee. RESULTS Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869). CONCLUSION This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups. LEVEL OF EVIDENCE Therapeutic/care management, Level IV.
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Affiliation(s)
- Kevin N Harrell
- From the Department of Surgery (K.N.H., R.A.M.), University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee; Department of Surgery (A.D.G., R.M.A.), University of Oklahoma, School of Medicine, Oklahoma City, Oklahoma; Department of Surgery (J.K.R., W.R.U.), University of Kentucky College of Medicine, Lexington, Kentucky; Department of Surgery (J.D.S., S.R.T.), Grady Health System, Emory University School of Medicine, Atlanta, Georgia; University of Texas at Austin (M.D.T., M.N.), Austin, Texas; Atrium Health Carolinas Medical Center (B.W.T., S.A.A.), Charlotte, North Carolina; Grant Medical Center (A.LR., M.C.S.), Columbus, Ohio; Department of Surgery (M.J.C., B.R.C.), Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Surgery (B.S.K., M.A.dM.), Medical College of Wisconsin Milwaukee, Wisconsin; Research Medical Center (M.J.L., J.M.C.), Kansas City, Missouri; Ascension Via Christi on St. Francis Hospital (J.M.H., K.L.L.), Wichita, Kansas; Department of Surgery (D.C.C., C.R.F.), Maine Medical Center, Portland, Maine; Department of Surgery (R.C.P.), Denver Health Medical Center, Denver, Colorado; Department of Surgery (M.T.K., H.B.A.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (P.O.U.), WakeMed Health Raleigh; Department of General Surgery (G.D.S., A.N.H.), Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Trauma/Acute Care Surgery (W.L.B., K.B.S.), Scripps Memorial Hospital La Jolla, La Jolla, California; Medical City Plano Hospital (G.M.) Plano, Texas; Department of Surgery (O.M., J.N.), University of California, School of Medicine, Irvine, Orange, California; Department of Pediatric Surgery (N.S., S.L.M.), Children's Hospital Colorado, Denver, Colorado
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Taghavi S, Maher Z, Goldberg AJ, Chang G, Mendiola M, Anderson C, Ninokawa S, Tatebe LC, Maluso P, Raza S, Keating JJ, Burruss S, Reeves M, Coleman LE, Shatz DV, Goldenberg-Sandau A, Bhupathi A, Spalding MC, LaRiccia A, Bird E, Noorbakhsh MR, Babowice J, Nelson MC, Jacobson LE, Williams J, Vella M, Dellonte K, Hayward TZ, Holler E, Lieser MJ, Berne JD, Mederos DR, Askari R, Okafor BU, Haut ER, Etchill EW, Fang R, Roche SL, Whittenburg L, Bernard AC, Haan JM, Lightwine KL, Norwood SH, Murry J, Gamber MA, Carrick MM, Bugaev N, Tatar A, Duchesne J, Tatum D. An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg 2021; 91:130-140. [PMID: 33675330 PMCID: PMC8216597 DOI: 10.1097/ta.0000000000003151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/01/2021] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP. METHODS This was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined. RESULTS Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01-1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02-28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85-18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33-10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables. CONCLUSION Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes. LEVEL OF EVIDENCE Prognostic, level III.
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