Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck?
Journal
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
ISSN: 1531-5053
Titre abrégé: J Oral Maxillofac Surg
Pays: United States
ID NLM: 8206428
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
01
02
2023
revised:
12
07
2023
accepted:
19
07
2023
medline:
6
11
2023
pubmed:
13
8
2023
entrez:
12
8
2023
Statut:
ppublish
Résumé
In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). Patient, injury, and hospital-related covariates were collected. Univariate analysis, χ Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.
Sections du résumé
BACKGROUND
In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited.
PURPOSE
The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU).
STUDY DESIGN, SETTING, SAMPLE
This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE
The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad).
MAIN OUTCOME VARIABLE(S)
The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no).
COVARIATES
Patient, injury, and hospital-related covariates were collected.
ANALYSES
Univariate analysis, χ
RESULTS
Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007].
CONCLUSION AND RELEVANCE
HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.
Identifiants
pubmed: 37572693
pii: S0278-2391(23)00768-1
doi: 10.1016/j.joms.2023.07.136
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1383-1390Informations de copyright
Copyright © 2023 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.