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Objectives: Evidence-based guidelines regarding the optimal mode of transport for trauma patients from scene to trauma centre are lacking. The purpose of this study was to investigate the relationship between trauma patient outcomes and mode of transport at a single Ontario Level I Trauma Centre, and specifically to investigate if the mode of transport confers a mortality benefit. Methods: A historical, observational cohort study was undertaken to compare rotor-wing and ground transported patients. Captured data included demographics, injury severity, temporal and mortality variables. TRISS-L analysis was performed to examine mortality outcomes. Results: 387 rotor-wing transport and 2,759 ground transport patients were analyzed over an 18-year period. Rotor-wing patients were younger, had a higher Injury Severity Score, and had longer prehospital transport times. Mechanism of injury was similarly distributed between groups. After controlling for heterogeneity with TRISS-L analysis, the mortality of rotor-wing patients was found to be lower than predicted mortality, whereas the converse was found with ground patients. Conclusion: Rotor-wing and ground transported trauma patients represent heterogeneous populations. Accounting for these differences, rotor-wing patients were found to outperform their predicted mortality, whereas ground patients underperformed predictions. [ABSTRACT FROM AUTHOR]