BACKGROUND:Balanced transfusion with (1:1:1) ratios of fresh frozen plasma (FFP), packed red blood cells (PRBCs), and platelets is a core tenet of management in traumatic hemorrhagic shock. However, preclinical data suggest that PRBCs transfusion may contribute to endothelial dysfunction, a complication that may be mitigated by FFP. We examined the impact of high FFP:PRBC ratios on mortality and major complications using the American College of Surgeons Trauma Quality Improvement Program database. METHODS:Trauma patients (18 years or older) in Trauma Quality Improvement Program (2017-2022) who received ≥1 U FFP and 1 U PRBC within 4 hours were included. Those transfused with whole blood or FFP:PRBC <0.9 were excluded. Patients were classified as balanced (FFP:PRBC 0.9-1.1) or excess FFP (FFP:PRBC >1.1), propensity matched based on odds of mortality, and compared by multivariate regression. RESULTS:Of 50,594 patients analyzed (75% male; median age, 38 years; Injury Severity Score, 25), 31,960 (63%) were classified as balanced, and 18,634 (37%) as excess FFP. Propensity matching generated 16,939 pairs (mean standard difference, <0.1). After multivariable adjustment, excess FFP was associated with 40% decreased odds of acute respiratory distress syndrome ( p < 0.001) and 32% decreased odds of acute kidney injury ( p = 0.027) compared with balanced transfusion, with no difference in hospital mortality (odds ratio, 1.01; 95% confidence interval, 0.92-1.11; p = 0.87). CONCLUSION:We found that early excess FFP (FFP:PRBC ratio >1.1) was associated with a significantly decreased odds of key complications compared with a strictly defined balanced transfusion (FFP:PRBC ratio 0.9-1.1), supporting further investigation of the potential benefits of plasma. ( J Trauma Acute Care Surg. 2026;100: 760-767. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved). LEVEL OF EVIDENCE:Therapeutic/Care Management; Level III.

INTRODUCTION:In response to blood shortages, providers face pressure to conserve blood. No metrics exist to calculate transfusion utility. We describe characteristics of survivors after high-volume resuscitation and evaluate transfusion utility in low-volume and high-volume resuscitation. METHODS:A retrospective analysis of 2019 American College of Surgeons Trauma Quality Improvement Program was performed on trauma patients ≥16 years old receiving transfusion within 4 hours of arrival. Patients excluded if they died in the emergency department, were dead on arrival, received <2 units of packed red blood cells, did not receive fresh-frozen plasma, or were missing data. High-volume survivors received more blood than 95% of the surviving population (≥17 U of packed red blood cells). High-volume mortality patients received ≥17 U of packed red blood cells and did not survive to discharge. Characteristics of high-volume survivors were identified by multivariable logistic regression. Utility of transfusion was compared between low-volume (<17 U of packed red blood cells) and high-volume (≥17 U of packed red blood cells) groups by totaling U transfused to yield 1 survivor. RESULTS:In total, 17,407 patients met study criteria, 12,585 (72%) survived. A total of 5.3% (663/12,585) of survivors were high-volume survivors. In total, 23% (1,112/4,823) of mortalities received ≥17 U of packed red blood cells. Low-volume survivors received a greater proportion of product than high-volume survivors (71% vs 34%, P < .001). Low-volume transfusions better used the blood supply (12.6 vs 130.8 U per survivor, P < .001). CONCLUSION:High-volume resuscitation yields few survivors and strains the blood supply. Standardized assessment protocols should identify patients with a favorable survival profile to guide allocation. Units transfused per survivor can be used to monitor the effect that blood-conservation protocols have on transfusion utility.

Firearm-related injuries in the USA are increasing, with over 105,000 cases annually. Gunshot wounds (GSWs), especially those involving retained bullets, present complex challenges due to bullet trajectories and embolization risks. This study reviews two cases of bullet emboli, focusing on bullet localization strategies and timing of removal. Imaging techniques such as chest X-ray, CT scan, intraoperative fluoroscopy, and transesophageal echocardiogram were employed for localization. In Case 1, a stable patient with a left-back GSW had a bullet embolism from the inferior vena cava to the right ventricle, necessitating prompt removal. In Case 2, an unstable patient with thoracoabdominal GSWs experienced a delayed embolism to the aortic root, requiring multiple surgeries. Effective management of retained bullets involves diverse imaging and timely surgical intervention, especially for stable patients, emphasizing individualized and proactive strategies to enhance outcomes in bullet embolization cases.

Background and Objectives: Previous studies have suggested that early scheduling of the surgical stabilization of rib fractures (SSRF) is associated with superior outcomes. It is unclear if these data are reproducible at other institutions. We hypothesized that early SSRF would be associated with decreased morbidity, length of stay, and total charges. Materials and Methods: Adult patients who underwent SSRF for multiple rib fractures or flail chest were identified in the National Inpatient Sample (NIS) by ICD-10 code from the fourth quarter of 2015 to 2016. Patients were excluded for traumatic brain injury and missing study variables. Procedures occurring after hospital day 10 were excluded to remove possible confounding. Early fixation was defined as procedures which occurred on hospital day 0 or 1, and late fixation was defined as procedures which occurred on hospital days 2 through 10. The primary outcome was a composite outcome of death, pneumonia, tracheostomy, or discharge to a short-term hospital, as determined by NIS coding. Secondary outcomes were length of hospitalization (LOS) and total cost. Chi-square and Wilcoxon rank-sum testing were performed to determine differences in outcomes between the groups. One-to-one propensity matching was performed using covariates known to affect the outcome of rib fractures. Stuart–Maxwell marginal homogeneity and Wilcoxon signed rank matched pair testing was performed on the propensity-matched cohort. Results: Of the 474 patients who met the inclusion criteria, 148 (31.2%) received early repair and 326 (68.8%) received late repair. In unmatched analysis, the composite adverse outcome was lower among early fixation (16.2% vs. 40.2%, p < 0.001), total hospital cost was less (USD114k vs. USD215k, p < 0.001), and length of stay was shorter (6 days vs. 12 days) among early SSRF patients. Propensity matching identified 131 matched pairs of early and late SSRF. Composite adverse outcomes were less common among early SSRF (18.3% vs. 32.8%, p = 0.011). The LOS was shorter among early SSRF (6 days vs. 10 days, p < 0.001), and total hospital cost was also lower among early SSRF patients (USD118k vs. USD183k late, p = 0.001). Conclusion: In a large administrative database, early SSRF was associated with reduced adverse outcomes, as well as improved hospital length of stay and total cost. These data corroborate other research and suggest that early SSRF is preferred. Studies of outcomes after SSRF should stratify analyses by timing of procedure.

Background: The critical blood shortage in January 2022 threatened the availability of blood. Utility of transfusion per unit was reported in a previous study, revealing patients receiving balanced transfusion are more likely to die after 16 units of packed red blood cells. We aimed to validate this study using a larger database. Methods: Retrospective analysis utilizing the American College of Surgeons Trauma Quality Improvement Program was performed. Trauma patients aged >= 16 receiving transfusion within 4 hours of arrival were included and excluded if they died in the emergency department, received <2 units of packed red blood cells, did not receive fresh frozen plasma, or were missing data. Primary outcome was mortality. Subgroups were balanced transfusion if receiving <= 2:1 ratio of packed red blood cells:fresh frozen plasma, and unbalanced transfusion if >2:1 ratio. Results: A total of 17,047 patients were evaluated with 28% mortality (4,822/17,408). Multivariable logistic regression identified advancing age (odds ratio 1.03 95% confidence interval 1.03-1.04), higher ISS (odds ratio 1.04, 95% confidence interval 1.03-1.04), and lower GCS (odds ratio 0.82, 95% confidence interval 0.82-0.83) as risk factors for mortality. Protective factors were balanced transfusion (odds ratio 0.81 95% confidence interval 0.71-0.93), male sex (odds ratio 0.90, 95% confidence interval 0.81-0.99), and blunt mechanism (odds ratio 0.74, 95% confidence interval 0.67-0.81). At 11 units of packed red blood cells, balanced transfusion patients were more likely to die (odds ratio 0.88, 95% confidence interval 0.80-0.98). Balanced transfusion patients survived at a higher rate for each unit of packed red blood cells, between 6 and 23 units of packed red blood cells. Conclusion: Mortality increases with each unit of packed red blood cell transfused. At 11 units of packed red blood cells, mortality is the more likely outcome. Balanced transfusion improves the chance of survival through 23 units of packed red blood cells.

Bullet embolism is a rare phenomenon where a bullet migrates from its original point of entry to a distant site within the body. This brief report describes a case of a bullet embolism entering the gastrointestinal (GI) tract through the posterior oropharynx. The patient initially presented with a gunshot wound to the left scapula, and the bullet was later identified in the GI tract. The patient was managed with a combination of endoscopic techniques and serial imaging, avoiding unnecessary surgical intervention. This case underscores the importance of comprehensive diagnostic strategies and tailored management in GI bullet embolism. It also emphasizes the utility of endoscopy in detecting GI tract injuries and highlights the successful use of non-operative management in specific scenarios.

High-energy, blunt force trauma to the abdomen results in an abdominal wall injury (AWI) in up to 9% of patients. In 1% of blunt abdominal trauma, they result in a traumatic abdominal wall hernia (TAWH). Optimal management of these injuries remains unclear. Because they are the result of a high-energy mechanism, concomitant serious abdominal organ injuries are common. This has prompted some to advocate that the presence of a TAWH on physical exam mandates exploratory laparotomy. However, delayed repairs have better outcomes and nontherapeutic celiotomy should be avoided. Similarly debated is the expanding use of minimally invasive techniques and the use of mesh for hernia repairs. Overall, the presence of a TAWH is likely not an absolute indication for emergency surgery. Rather, it is an indicator of high-energy impact and associated with a high rate of visceral injury. These patients require a close observation for clinical decline and development of typical indicators for laparotomy.

Introduction: Penetrating carotid artery injury is rare and particularly uncommon in zone 3 of the vessel. Due to anatomical challenges to open operative management in zone 3, there are minimal treatment recommendations for this highly morbid condition. The urgency associated with understanding proper management of this traumatic injury is further supported by the nearly 100 % rate of fatality in untreated penetrating carotid artery injuries. Presentation of case: A 17-year-old male presented with a bullet wound to the right temple. He was intubated for airway protection given left-sided tracheal deviation secondary to a right neck hematoma. His Glasgow Coma Scale (GCS) was 11 on initial presentation, E3V2M6. The patient remained hemodynamically stable and underwent a CT angiogram of the head and neck. Imaging revealed a complete transection of the cervical (zone III) right internal carotid artery (RICA), a large pseudoaneurysm of the RICA distal to carotid bifurcation, and comminuted mandibular fracture. Collateral blood flow was preserved to the right hemisphere. Multidisciplinary discussions deemed risks of operative intervention outweighed the benefits in the immediate peritrauma period as the increased risk of hemispheric stroke, exsanguination, and death was thought to be prohibitive. Therefore, treatment of delayed intervascular stenting of the RICA was performed as opposed to emergent open RICA ligation or repair. Discussion: Treatment decisions for zone 3 CAI rely on the patient's hemodynamic stability, with surgical ligation favored for immediate hemorrhage control in unstable cases, while stable patients may undergo observation or delayed endovascular intervention. Balancing the need for hemostasis to prevent further blood loss with the potential benefits of anticoagulation to maintain cerebral perfusion underscores the decision-making required in managing such cases. Conclusion: The rarity and challenge of ICA injury at this anatomical location presents unique challenges. Our description of observation and delayed revascularization outlines the precarious, yet validated, treatment method for hemodynamically stable patients.

Background The critical blood shortage in January 2022 threatened the availability of blood. Utility of transfusion per unit was reported in a previous study, revealing patients receiving balanced transfusion are more likely to die after 16 units of packed red blood cells. We aimed to validate this study using a larger database. Methods Retrospective analysis utilizing the American College of Surgeons Trauma Quality Improvement Program was performed. Trauma patients aged ≥16 receiving transfusion within 4 hours of arrival were included and excluded if they died in the emergency department, received <2 units of packed red blood cells, did not receive fresh frozen plasma, or were missing data. Primary outcome was mortality. Subgroups were balanced transfusion if receiving ≤2:1 ratio of packed red blood cells:fresh frozen plasma, and unbalanced transfusion if >2:1 ratio. Results A total of 17,047 patients were evaluated with 28% mortality (4,822/17,408). Multivariable logistic regression identified advancing age (odds ratio 1.03 95% confidence interval 1.03–1.04), higher ISS (odds ratio 1.04, 95% confidence interval 1.03–1.04), and lower GCS (odds ratio 0.82, 95% confidence interval 0.82–0.83) as risk factors for mortality. Protective factors were balanced transfusion (odds ratio 0.81 95% confidence interval 0.71–0.93), male sex (odds ratio 0.90, 95% confidence interval 0.81–0.99), and blunt mechanism (odds ratio 0.74, 95% confidence interval 0.67–0.81). At 11 units of packed red blood cells, balanced transfusion patients were more likely to die (odds ratio 0.88, 95% confidence interval 0.80–0.98). Balanced transfusion patients survived at a higher rate for each unit of packed red blood cells, between 6 and 23 units of packed red blood cells. Conclusion Mortality increases with each unit of packed red blood cell transfused. At 11 units of packed red blood cells, mortality is the more likely outcome. Balanced transfusion improves the chance of survival through 23 units of packed red blood cells.

A 20-year-old woman with previous COVID-19 diagnosis presented with abdominal pain and colitis on CT scan. She was admitted in septic shock, with etiology of colitis unclear. After resuscitation, antibiotics, and steroids, she clinically deteriorated. Worsening Clostridioides difficile infection was most likely and she was taken to the operating room. Intraoperatively, only a segment of transverse colon appeared abnormal on gross and endoscopic evaluation. Total colectomy was deferred in favor of segmental resection. Given her unusual disease pattern and recent COVID-19 infection, diagnosis of MIS-C was considered. Steroids were continued and treatment broadened to include heparin and IVIG. The patient returned to the operating room for planned reexploration, endoscopy, and end colostomy. On hospital day three, the patient had an acute mental status change. Computed tomography demonstrated acute cerebral edema with brainstem herniation. The family chose comfort-care measures. Final pathology from the transverse colon demonstrated COVID-19-associated vasculitis.

Loudon, Andrew M.; Rushing, Amy P.; Hue, Jonathan J.; Moorman, Matthew L. Author Information

INTRODUCTION The American Association for the Surgery of Trauma Colon Organ Injury Scale (OIS) was updated in 2020 to include a separate OIS for penetrating colon injuries and included imaging criteria. In this multicenter study, we describe the contemporary management and outcomes of penetrating colon injuries and hypothesize that the 2020 OIS system correlates with operative management, complications, and outcomes. METHODS This was a retrospective study of patients presenting to 12 Level 1 trauma centers between 2016 and 2020 with penetrating colon injuries and Abbreviated Injury Scale score of <3 in other body regions. We assessed the association of the new OIS with surgical management and clinical outcomes and the association of OIS imaging criteria with operative criteria. Bivariate analysis was done with χ 2 , analysis of variance, and Kruskal-Wallis, where appropriate. Multivariable models were constructed in a stepwise selection fashion. RESULTS We identified 573 patients with penetrating colon injuries. Patients were young and predominantly male; 79% suffered a gunshot injury, 11% had a grade V destructive injury, 19% required ≥6 U of transfusion, 24% had an Injury Severity Score of >15, and 42% had moderate-to-large contamination. Higher OIS was independently associated with a lower likelihood of primary repair, higher likelihood of resection with anastomosis and/or diversion, need for damage-control laparotomy, and higher incidence of abscess, wound infection, extra-abdominal infections, acute kidney injury, and lung injury. Damage control was independently associated with diversion and intra-abdominal and extra-abdominal infections. Preoperative imaging in 152 (27%) cases had a low correlation with operative findings ( κ coefficient, 0.13). CONCLUSION This is the largest study to date of penetrating colon injuries and the first multicenter validation of the new OIS specific to these injuries. While imaging criteria alone lacked strong predictive value, operative American Association for the Surgery of Trauma OIS colon grade strongly predicted type of interventions and outcomes, supporting use of this grading scale for research and clinical practice. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.

Population Health ManagementVol. 26, No. 5 Points of ViewData-Driven Leadership: Clinical Registries Drive Higher Value Health CareMatthew L. Moorman, Andrew M. Loudon, and Peter J. PronovostMatthew L. MoormanAddress correspondence to: Matthew L. Moorman, MD, MBA, FACS, FAWM, FCCM, Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Suite 6200, Cleveland, OH 44106, USA E-mail Address: [email protected]Department of Surgery and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Search for more papers by this author, Andrew M. LoudonDepartment of Surgery and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Search for more papers by this author, and Peter J. Pronovosthttps://orcid.org/0000-0002-9740-3775Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Department of Anesthesia, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Search for more papers by this authorPublished Online:10 Oct 2023https://doi.org/10.1089/pop.2023.0066AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 26Issue 5Oct 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Matthew L. Moorman, Andrew M. Loudon, and Peter J. Pronovost.Data-Driven Leadership: Clinical Registries Drive Higher Value Health Care.Population Health Management.Oct 2023.353-355.http://doi.org/10.1089/pop.2023.0066Published in Volume: 26 Issue 5: October 10, 2023Online Ahead of Print:June 21, 2023PDF download

Badrinathan, Avanti MD; Ebertz, David MD; Acosta, Gi-Ann A MD; Kishawi, Sami MD; Nash, Joshua E DO, FACS; Moorman, Matthew L MD, FACS; Rushing, Amy Page Associate Professor - Clinical; Loudon, Andrew MD, FACS Author Information

BACKGROUND: Balanced transfusion is lifesaving for hemorrhagic shock. The American Red Cross critical blood shortage in 2022 threatened the immediate availability of blood. To eliminate waste, we reviewed the utility of transfusions per unit to define expected mortality at various levels of balanced transfusion. METHODS: A retrospective study of 296 patients receiving massive transfusion on presentation at a level 1 trauma center was performed from January 2018 to December 2021. Units of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets received in the first 4 hours were recorded. Patients were excluded if they died in the emergency department, died on arrival, received <2 U PRBCs or FFP, or received PRBC/FFP >2:1. Primary outcomes were mortality and odds of survival to discharge. Subgroups were defined as transfused if receiving 2 to 9 U PRBCs, massive transfusion for 10 to 19 U PRBCs, and ultramassive transfusion for >= 20 U PRBCs. RESULTS: A total of 207 patients were included (median age, 32 years; median Injury Severity Score, 25; 67% with penetrating mechanism). Mortality was 29% (61 of 207 patients). Odds of survival is equal to odds of mortality at 11 U PRBCs (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.50-1.79). Beyond 16 U PRBCs, odds of mortality exceed survival (OR, 0.36; 95% CI, 0.16-0.82). Survival approaches zero >36 U PRBCs (OR, 0.09; 95% CI, 0.00-0.56). Subgroup mortality rates increased with unit transfused (16% transfused vs. 36% massive transfusion, p = 0.003; 36% massive transfusion vs. 67% ultramassive transfusion, p = 0.006). CONCLUSION: Mortality increases with each unit balanced transfusion. Surgeons should view efforts heroic beyond 16 U PRBCs/4 hours and near futile beyond 36 U PRBCs/4 hours. While extreme outliers can survive, consider cessation of resuscitation beyond 36 U PRBCs. This is especially true if hemostasis has not been achieved or blood supplies are limited.

Background Surgical stabilization of rib fractures (SSRF) is performed on only a small subset of patients who meet guideline-recommended indications for surgery. Although previous studies show that provider specialization was associated with SSRF procedural competency, little is known about the impact of provider specialization on SSRF performance frequency. We hypothesize that provider specialization would impact performance of SSRF.Methods The Premier Hospital Database was used to identify adult patients with rib fractures from 2015 and 2019. The outcome of interest was performance of SSRF, defined using International Classification of Diseases—10th Revision Procedure Coding System coding. Patients were categorized as receiving their procedures from a thoracic, general surgeon, or orthopedic surgeon. Patients with missing or other provider types were excluded. Multivariate modeling was performed to evaluate the effect of surgical specialization on outcomes of SSRF. Given a priori assumptions that trauma centers may have different practice patterns, a subgroup analysis was performed excluding patients with ‘trauma center’ admissions.Results Among 39 733 patients admitted with rib fractures, 2865 (7.2%) received SSRF. Trauma center admission represented a minority (1034, 36%) of SSRF procedures relative to other admission types (1831, 64%, p=0.15). In a multivariable analysis, thoracic (OR 6.94, 95% CI 5.94–8.11) and orthopedic provider (OR 2.60, 95% CI 2.16–3.14) types were significantly more likely to perform SSRF. In further analyses of trauma center admissions versus non-trauma center admissions, this pattern of SSRF performance was found at non-trauma centers.Conclusion The majority of SSRF procedures in the USA are being performed by general surgeons and at non-trauma centers. ‘Subspecialty’ providers in orthopedics and thoracic surgery are performing fewer total SSRF interventions, but are more likely to perform SSRF, especially at non-trauma centers. Provider specialization as a barrier to SSRF may be related to competence in the SSRF procedures and requires further study.Type Therapeutic/care management.Level of evidence IV

Nearly all undergraduate biomedical engineering programs teach some form of human physiology. How this is taught, by what faculty (engineering, anatomy, etc.) is variable. Physiology, as classically taught in texts, contains little quantitative relationships of interest to engineers. Two practicing critical care surgeons with engineering backgrounds have encountered enumerable clinical problems ripe for engineering solutions. Some of the more common, such as intravascular volume during resuscitation, optimum ventilator tidal volumes delivered to diseased lungs, and assessment of injured tissue viability at surgery, are presented as engineering problems in the context of actual bedside utility. Mathematical models are utilized for quantitative analysis of these clinical principles. These clinical correlations enable synthesis of basic engineering concepts around applications in medical practice. Students draw upon prior training in biophysics, anatomic structure and function, and mathematical modeling of physiologic systems. Blending engineering and clinical concepts in this fashion expand student's medical expertise. The curriculum maintains two overriding concepts throughout eight modules: (i) How physicians think versus how engineers think and (ii) Learning the language of the customer. This eight-week course featured critical care cases designed to associate and translate engineering concepts into relevant medical knowledge. In this "flipped" course, surgeon-instructors pose actual clinical scenarios where they see a need for an engineering solution. Students were expected to prepare for each class and actively participate in a physician-lead discussion involving a clinical problem for which asking for proposed solutions. Post-case homework was a written reflection of about 1000 words describing their understanding of the problem and their proposed initial solutions. These written assignments and their attendance were used to calculate a final grade. The course was taught for the first time in the Fall semester of 2021. Formal feedback is still pending. Students provide immediate critique of the course by their attendance which was 100% over eight weeks. Informal feedback to the full-time engineering faculty member was universally positive. Planned revisions to the course include relying more on the flipped classroom model and spending less time reviewing basic concepts. This leaves more time for discussion of the clinical scenarios which highlight the need for engineering solutions. The curriculum will likely be taught twice each year and possibly expanded to include graduate-level student who desire additional training in basic physiology principles and their application.

OBJECTIVES:Amid growing calls for police reform, it is imperative to reassess whether police actions designed to improve public safety are associated with injury prevention. This study aims to examine the relationship between the police traffic stops (PTSs) and motor vehicle crash (MVC) deaths at the state level. We hypothesize that increased PTSs would be associated with reduced MVC deaths.METHODS:We retrospectively analyzed PTSs and MVC deaths at the state level from 2004 to 2016. Police traffic stops data were from 33 state patrols from the Stanford Open Policing Project. The MVC deaths data were collected from the National Highway Traffic Safety Administration. The vehicle miles traveled data were from the Federal Highway Administration Office of Highway Policy Information. All data were adjusted per 100 million vehicle miles traveled (100MVMT) and were analyzed as state-level time series cross-sectional data. The dependent variable was MVC deaths per 100MVMT, and the independent variable was number of PTSs per 100MVMT. We performed panel data analysis accounting for random and fixed state effects and changes over time.RESULTS:Thirty-three state patrols with 235 combined years were analyzed, with a total of 161,153,248 PTSs. The PTS rate varied by state and year. Nebraska had the highest PTS rate (3,637/100MVMT in 2004), while Arizona had the lowest (0.17/100MVMT in 2009). Motor vehicle crash deaths varied by state and year, with the highest death rate occurring in South Carolina in 2005 (2.2/100MVMT) and the lowest in Rhode Island in 2015 (0.57/100MVMT). After accounting for year and state-level variability, no association was found between PTS and the MVC death rates.CONCLUSION:State patrol traffic stops are not associated with reduced MVC deaths. Strategies to reduce death from MVC should consider alternative strategies, such as motor vehicle modifications, community-based safety initiatives, improved access to health care, or prioritizing trauma system.LEVEL OF EVIDENCE:Retrospective epidemiological study, level IV.