• Kristan Staudenmayer, Renee Hsia, Ewen Wang, Karl Sporer, David Ghilarducci, David Spain, Robert Mackersie, John Sherck, Richard Kline, and Craig Newgard.
• Stanford University School of Medicine, Stanford, California 94305-5641, USA. kristans@stanford.edu
• J Trauma Acute Care Surg. 2012 Mar 1;72(3):594-9; discussion 599-600.

BackgroundInjured patients who are not transported by an ambulance to the hospital are often not included in trauma registries. The outcomes of these patients have until now been unknown. Understanding what happens to nontransports is necessary to better understand triage validity, patient outcomes, and costs associated with injury. We hypothesized that a subset of patients who were not transported from the scene would later present for evaluation and that these patients would have a nonzero mortality rate.MethodsThis is a population-based, retrospective cohort study of injured adults and children for three counties in California from 2006 to 2008. Prehospital data for injured patients for whom an ambulance was dispatched were probabilistically linked to trauma registry data from four trauma centers, state-level discharge data, emergency department records, and death files (1-year mortality).ResultsA total of 69,413 injured persons who were evaluated at the scene by emergency medical services were included in the analysis. Of them, 5,865 (8.5%) were not transported. Of those not transported, 1,616 (28%) were later seen in an emergency department and discharged and 92 (2%) were admitted. Seven (0.2%) patients later died.ConclusionPatients evaluated by emergency medical services, but not initially transported from the field after injury, often present later to the hospital. The mortality rate in this population was not zero, and these patients may represent preventable deaths.Level Of EvidenceIII, therapeutic study.

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