Prehospital transport prioritization and time-varying selection bias in traffic-related multi-patient incidents: a nationwide retrospective cohort study
Authors' conclusion
The association between priority transport and severe outcome was modified by on-scene time, with the largest risk difference at the shortest on-scene times.
Study context
- Population
- Patients from traffic-related multi-patient incidents (≥2 patients per incident) with complete data, Fire and Disaster Management Agency of Japan EMS transport records, January 2021-December 2023of 13,821,224 records
- Participants
- 143,130 patients
- Exposure
- Priority transport vs non-priority transport
- Priorityn = 62,769
- Outcome
- Physician-assessed death or critical/severe injury at hospital arrival
- Follow-up
- Hospital arrival
Methodological detailsnationwide, augmented inverse probability weighting (doubly robust), cluster-bootstrap CIs, E-value sensitivity analysis
- Nationwide
- Augmented inverse probability weighting (doubly robust)
- Cluster-bootstrap CIs
- E-value sensitivity analysis
Main finding
As reported in the abstract
Death or critical/severe injury at hospital arrival
- Overall marginal adjusted RD, priority vs non-priority transport (AIPW)
- 2.2% points (95% CI, 2.01-2.36)
Observational data: associations, not effects.
Further findings
Effect modification of RD by on-scene time (5-60 min)
Points
- Marginal RD at 5 min (peak)
- 6.4% (95% CI, 5.6-7.2)
- Marginal RD at ≈32 min (minimum)
- 1.4% (95% CI, 1.3-1.6)
- Marginal RD at 60 min
- 2.4% (95% CI, 2.0-2.8)
- Interaction with on-scene time p < .001
- Cluster-bootstrap CIs
Sensitivity analyses (unmeasured confounding)
- E-value
- 3.76 (lower bound, 3.57)
- Sensitivity analyses confirmed result robustness
Original publication
Prehospital transport prioritization and time-varying selection bias in traffic-related multi-patient incidents: a nationwide retrospective cohort study. Crit Care. Published 4 August 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →