Evaluation of the prehospital characteristics of traumatic amputation cases: A retrospective observational study

This study aimed to comprehensively assess the epidemiological, etiological, and operational characteristics of prehospital traumatic amputations with a specific focus on demographic patterns, injury mechanisms, anatomical distribution, and emergency medical services (EMS) response intervals and distances.

This retrospective observational study initially assessed 1704 suspected traumatic amputation cases recorded in the Ankara Ambulance Service Operations System between January 2018 and December 2023. After applying the exclusion criteria of on-scene death (n = 60), interfacility transfer (n = 556), and non-amputation trauma (n = 72), a total of 1016 eligible cases were included in the final analysis. Extracted variables included patient demographics, injury etiology, extremity involvement (upper vs. lower), urban vs. rural location, prehospital vital signs, and operational metrics (dispatch-to-arrival, on-scene, and scene-to-hospital times and corresponding distances). Statistical analyses entailed chi-square or Fisher exact tests for categorical variables, t-tests or Mann-Whitney U tests for continuous variables, and Bonferroni corrections for multiple comparisons.

The median age of the patients was 32 years (IQR: 21-47) and 75.8% were male. Upper extremity amputations predominated (79.5%), particularly in cases of occupational (86.5%) and domestic (86.1%) injuries, while lower extremity amputations were more frequent in traffic accidents (34.9%). Occupational accidents were significantly more common among men and domestic accidents among women (p < 0.001, Bonferroni-adjusted). Rural patients had significantly longer call-to-arrival times (median: 15.0 vs. 8.0 min), scene-to-hospital times (21.0 vs. 13.0 min), and total distances (median 45.0 vs. 17.0 km) than urban patients (all p < 0.001). Traffic accidents had the longest on-scene times (median: 10.8 min) compared to occupational (9.0 min) and domestic (8.8 min) injuries (p < 0.001). Vital signs showed no significant differences between upper and lower extremity cases.

Prehospital traumatic amputations in this large cohort displayed clear demographic and etiological trends, with upper extremity injuries predominating and distinct sex- and mechanism-specific patterns. Rural-urban disparities in prehospital times and distances were pronounced and traffic-related amputations required longer on-scene management. These findings highlight the need for targeted prevention strategies, EMS workflow optimization, and the strengthening of rural trauma systems to improve survival and limb salvage outcomes.