Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports

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• 作者：Brian R. Englum^a ; ^{brian.englum@duke.edu} ; Kristy L. Rialon^a ; Jina Kim^a ; Mark L. Shapiro^b ; John E. Scarborough^b ; Henry E. Rice^c ; Obinna O. Adibe^c ; Elisabeth T. Tracy^c
• 关键词：Pediatric trauma ; Helicopter emergency medical services ; Transport mode ; Survival ; Comparative effectiveness analysis
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：140-144
• 全文大小：426 K
• 卷排序：52

文摘

The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries.MethodsAll blunt/penetrating trauma patients ≤ 18 years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS) ≥ 9 were included.ResultsOf 127,489 included patients, 18,291 (14%) arrived via HEMS, compared to 56% by ground ambulance and 29% by private vehicle/walk-in. HEMS patients had more severe injuries (ISS ≥ 25; 28% vs. 14%) and altered mental status (GCS ≤ 8; 29% vs. 11%), but also contained many patients with only minor injuries or no major physiologic derangements. In unadjusted analysis, HEMS was associated with increased mortality (OR: 1.6; 95% CI: 1.4–1.7). However, it had decreased mortality by regression (0.5; 0.4–0.6) and propensity analysis (0.7; 0.6–0.8) to adjust for confounders.ConclusionWe found multiple indicators for overuse of HEMS, with nearly 40% of children having only minor injuries. In moderate/severe injuries, HEMS is associated with decreased mortality, potentially saving one life for every 47 flights. Research is needed to determine appropriate criteria for helicopter triage.Comparative Study/Level of evidenceIII