Direct Trauma Center Access by Helicopter Emergency Medical Services is Associated With Improved Survival After Severe Injury.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 10 2023
01 10 2023
Historique:
pmc-release:
01
10
2024
medline:
11
9
2023
pubmed:
4
2
2023
entrez:
3
2
2023
Statut:
ppublish
Résumé
Evaluate the association of survival with helicopter transport directly to a trauma center compared with ground transport to a non-trauma center (NTC) and subsequent transfer. Helicopter transport improves survival after injury. One potential mechanism is direct transport to a trauma center when the patient would otherwise be transported to an NTC for subsequent transfer. Scene patients 16 years and above with positive physiological or anatomic triage criteria within PTOS 2000-2017 were included. Patients transported directly to level I/II trauma centers by helicopter were compared with patients initially transported to an NTC by ground with a subsequent helicopter transfer to a level I/II trauma center. Propensity score matching was used to evaluate the association between direct helicopter transport and survival. Individual triage criteria were evaluated to identify patients most likely to benefit from direct helicopter transport. In all, 36,830 patients were included. Direct helicopter transport was associated with a nearly 2-fold increase in odds of survival compared with NTC ground transport and subsequent transfer by helicopter (aOR 2.78; 95% CI 2.24-3.44, P <0.01). Triage criteria identifying patients with a survival benefit from direct helicopter transport included GCS≤13 (1.71; 1.22-2.41, P <0.01), hypotension (2.56; 1.39-4.71, P <0.01), abnormal respiratory rate (2.30; 1.36-3.89, P <0.01), paralysis (8.01; 2.03-31.69, P <0.01), hemothorax/pneumothorax (2.34; 1.36-4.05, P <0.01), and multisystem trauma (2.29; 1.08-4.84, P =0.03). Direct trauma center access is a mechanism driving the survival benefit of helicopter transport. First responders should consider helicopter transport for patients meeting these criteria who would otherwise be transported to an NTC.
Sections du résumé
OBJECTIVE
Evaluate the association of survival with helicopter transport directly to a trauma center compared with ground transport to a non-trauma center (NTC) and subsequent transfer.
SUMMARY BACKGROUND DATA
Helicopter transport improves survival after injury. One potential mechanism is direct transport to a trauma center when the patient would otherwise be transported to an NTC for subsequent transfer.
METHODS
Scene patients 16 years and above with positive physiological or anatomic triage criteria within PTOS 2000-2017 were included. Patients transported directly to level I/II trauma centers by helicopter were compared with patients initially transported to an NTC by ground with a subsequent helicopter transfer to a level I/II trauma center. Propensity score matching was used to evaluate the association between direct helicopter transport and survival. Individual triage criteria were evaluated to identify patients most likely to benefit from direct helicopter transport.
RESULTS
In all, 36,830 patients were included. Direct helicopter transport was associated with a nearly 2-fold increase in odds of survival compared with NTC ground transport and subsequent transfer by helicopter (aOR 2.78; 95% CI 2.24-3.44, P <0.01). Triage criteria identifying patients with a survival benefit from direct helicopter transport included GCS≤13 (1.71; 1.22-2.41, P <0.01), hypotension (2.56; 1.39-4.71, P <0.01), abnormal respiratory rate (2.30; 1.36-3.89, P <0.01), paralysis (8.01; 2.03-31.69, P <0.01), hemothorax/pneumothorax (2.34; 1.36-4.05, P <0.01), and multisystem trauma (2.29; 1.08-4.84, P =0.03).
CONCLUSIONS
Direct trauma center access is a mechanism driving the survival benefit of helicopter transport. First responders should consider helicopter transport for patients meeting these criteria who would otherwise be transported to an NTC.
Identifiants
pubmed: 36735480
doi: 10.1097/SLA.0000000000005812
pii: 00000658-990000000-00375
pmc: PMC10397363
mid: NIHMS1868022
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e840-e847Subventions
Organisme : NIGMS NIH HHS
ID : T32 GM008516
Pays : United States
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
J Trauma Acute Care Surg. 2019 Jun;86(6):1015-1022
pubmed: 31124900
J Trauma Acute Care Surg. 2018 Jul;85(1):174-181
pubmed: 29787553
JAMA. 2005 Jun 1;293(21):2626-33
pubmed: 15928284
J Am Coll Surg. 2019 Jan;228(1):9-20
pubmed: 30359830
Crit Care. 2013 Jul 16;17(4):169
pubmed: 23890322
Biomed J. 2021 Dec;44(6 Suppl 1):S110-S118
pubmed: 35735080
J Trauma. 2010 Nov;69(5):1030-4; discussion 1034-6
pubmed: 21068607
Prehosp Emerg Care. 2016;20(1):6-14
pubmed: 26017368
J Trauma Acute Care Surg. 2013 Oct;75(4):734-41
pubmed: 24064891
J Trauma Acute Care Surg. 2016 Jul;81(1):93-100
pubmed: 26886000
J Trauma Acute Care Surg. 2017 Jul;83(1):111-118
pubmed: 28422905
Prehosp Emerg Care. 2014;18 Suppl 1:35-44
pubmed: 24279767
J Trauma Acute Care Surg. 2020 Jun;88(6):734-741
pubmed: 32453256
J Trauma Acute Care Surg. 2020 Jul;89(1):246-253
pubmed: 32195996
West J Emerg Med. 2019 Jul;20(4):601-609
pubmed: 31316699
J Trauma. 2006 Jun;60(6):1250-6; discussion 1256
pubmed: 16766968
Injury. 2017 Feb;48(2):332-338
pubmed: 28069138
J Trauma Acute Care Surg. 2018 Apr;84(4):549-557
pubmed: 29251708
J Trauma Acute Care Surg. 2021 Jun 1;90(6):967-972
pubmed: 34016920
J Am Coll Surg. 2016 Feb;222(2):146-58.e2
pubmed: 26712244
JAMA. 2012 Apr 18;307(15):1602-1610
pubmed: 22511688
J Emerg Trauma Shock. 2013 Jan;6(1):16-20
pubmed: 23494152
J Trauma Acute Care Surg. 2017 Feb;82(2):270-279
pubmed: 27906867
J Trauma Acute Care Surg. 2012 Jun;72(6):1510-5; discussion 1515-7
pubmed: 22695414
Surgery. 2016 Mar;159(3):947-59
pubmed: 26603848
JAMA Surg. 2018 Mar 1;153(3):261-268
pubmed: 29094162
J Surg Res. 2017 Oct;218:261-270
pubmed: 28985859
Cochrane Database Syst Rev. 2015 Dec 15;(12):CD009228
pubmed: 26671262
J Trauma Acute Care Surg. 2013 Jul;75(1):92-6; discussion 96
pubmed: 23778445
Prehosp Emerg Care. 2011 Jul-Sep;15(3):295-302
pubmed: 21524205
Am J Surg. 2016 Dec;212(6):1101-1105
pubmed: 27832843
J Trauma. 2010 Sep;69(3):595-9; discussion 599-601
pubmed: 20838131
Acad Emerg Med. 2011 Nov;18(11):1208-16
pubmed: 22092906
J Trauma Acute Care Surg. 2021 Jul 1;91(1):178-185
pubmed: 33605701
Ann Emerg Med. 2019 Dec;74(6):786-794
pubmed: 31248674
J Trauma. 2006 Jun;60(6):1257-65; discussion 1265-6
pubmed: 16766969
Ann Surg. 2011 Jun;253(6):1178-83
pubmed: 21494125
J Trauma. 2007 Nov;63(5):965-71
pubmed: 17993937
Ann Surg. 2016 Aug;264(2):378-85
pubmed: 26501703