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Duffens A, Grigorian A, de Virgilio C, Chin T, Kim D, Lekawa M, Schubl SD, Nahmias J. Association of Risk of Mortality in Pediatric Patients Transferred From Scene by Helicopter With Major But Not Minor Injuries. Pediatr Emerg Care 2022; 38:e287-e291. [PMID: 33105460 DOI: 10.1097/pec.0000000000002263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Helicopter emergency medical services (HEMS) are used for 16% of pediatric trauma. National HEMS guidelines advised that triage criteria be standardized for pediatric patients. A national report found pediatric HEMS associated with decreased mortality compared with ground emergency medical services (GEMS) but did not control for transport time. We hypothesized that the rate of HEMS has decreased nationally and the mortality risk for HEMS to be similar when adjusting for transport time compared with GEMS. METHODS The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients younger than 16 years transported by HEMS or GEMS. A multivariable logistic regression was used. RESULTS From 25,647 patients, 4527 (17.7%) underwent HEMS. The rate of HEMS from scene decreased from 21.2% in 2014 to 18.2% in 2016. The rate of HEMS for minor trauma (Injury Severity Score <15) decreased from 14.9% in 2014 to 13.5% in 2016 and major trauma (Injury Severity Score > 15) from 38.4% in 2014 to 35.9% in 2016. After controlling for predictors of mortality and transport time, HEMS was associated with decreased risk of mortality for only those with major injuries transferred from scene (odds ratio, 0.48; 95% confidence interval, 0.26-0.88; P = 0.01) compared with GEMS. CONCLUSIONS The rate of HEMS in pediatric trauma has decreased. However, there is room for improvement as 14% of those with minor trauma are transported by HEMS. Given the similar risk of mortality compared with GEMS, further development of guidelines that avoid the unnecessary use of HEMS appears warranted. However, utilization of HEMS for transport of pediatric major trauma should continue.
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Affiliation(s)
- Ali Duffens
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Areg Grigorian
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | | | - Theresa Chin
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Dennis Kim
- Department of Surgery, Harbor-University of California, Los Angeles, Torrance, CA
| | - Michael Lekawa
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Sebastian D Schubl
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Jeffry Nahmias
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
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Nemeth ZH, Soliman SS, Rolandelli RH, Durling-Grover R, DiFazio LT. How to Better Triage Trauma Patients for Helicopter Transport. Am Surg 2021; 88:1732-1733. [PMID: 34049439 DOI: 10.1177/00031348211023393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zoltan H Nemeth
- Department of Surgery, 5638Morristown Medical Center, Morristown, NJ, USA
| | - Sara S Soliman
- Department of Surgery, 5638Morristown Medical Center, Morristown, NJ, USA
| | | | | | - Louis T DiFazio
- Department of Surgery, 5638Morristown Medical Center, Morristown, NJ, USA
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Brown C, Irfan W, Schoen JE, Marr AB, Stuke LE, Cavalea AC, Mosier WW, Rogers CL, Greiffenstein PP, Moore MM, Hunt JP. Predictors of Inappropriate Helicopter Transport. Am Surg 2020; 87:248-252. [DOI: 10.1177/0003134820951423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Helicopter transport (HT) is an efficient, but costly, means for injured patients to receive life-saving, definitive trauma care. Identifying the characteristics of inappropriate HT presents an opportunity to improve the utilization of this finite medical resource. Methods Trauma registry records of all HT for a 3-year period (2016-2018) to an urban Level I trauma center were reviewed. HT was defined as inappropriate for patients who were discharged home from the emergency department or had a hospital length of stay <1 day, and who were discharged alive. Chi-square analysis and Student’s t-test were used for univariate analysis. Predictors with a P value of less than .15 were subject to binary logistic regression analysis. A P value ≤.05 was considered significant. Results There were 713 patients who received HT during the study period. One-hundred and forty-eight (20.8%) patients met the criteria as an inappropriate HT. In univariate analysis, Glasgow Coma Scale >8, Shock Index <0.9, and fall mechanism were found to be significantly associated with inappropriate HT. Age >55 was found to be associated with an appropriate HT. The average Injury Severity Score of the inappropriate HT group was 3.86 (±3.85) compared with 16.80 (±11.23) ( P = .0001, Student’s t-test). Discussion Our findings suggest that there are evidence-based predictors of patients receiving inappropriate HT. Triage of HT using these predictors has the potential to decrease unnecessary deployments and reduce health care costs.
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Affiliation(s)
- Christopher Brown
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Wajeeh Irfan
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Jonathan E. Schoen
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Alan B. Marr
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Lance E. Stuke
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Alexander C. Cavalea
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Willard W. Mosier
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Camille L. Rogers
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Patrick P. Greiffenstein
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - Margaret M. Moore
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
| | - John P. Hunt
- Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA, USA
- Department of Surgery, Norman E. McSwain Level I Trauma Center at University Medical Center, New Orleans, LA, USA
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Horwood CR, Ricci K, Sobol CG, Evans D, Eiferman D. Stop Flying the Patients! Evaluation of the Overutilization of Helicopter Transport of Trauma Patients. J Surg Res 2020; 256:290-294. [PMID: 32712443 DOI: 10.1016/j.jss.2020.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/08/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Helicopter transport is a resource intensive and expensive method for transportation of patients by helicopter. The primary objective of this study was to evaluate the appropriateness of helicopter transport determined by procedural care within 1-h of transfer at an urban level I trauma center. METHODS All trauma patients transported by helicopter from January 2015-December 2017 to an urban level I trauma center from referring hospitals or the scene were retrospectively analyzed. A subgroup analysis was performed evaluating patients that required a procedure or operation within 1-h of transport compared with the remainder of the patient cohort who were transported via helicopter. RESULTS A total of 1590 patients were transported by helicopter. Thirty-nine percent of patients (n = 612) were admitted directly to the floor from the trauma bay and 16% (n = 249) of patients required only observation or were discharged home after helicopter transfer. Approximately one-third of the entire study cohort (36%, n = 572) required any procedure, with a median time to procedure of 31.5 h (interquartile range 54.4). Only 13% (n = 74) required a procedure within 1-h of helicopter transport. The average distance (in miles) if the patient had been driven by ground transport rather than helicopter was 67.0 miles (SD ± 27.9) and would take an estimated 71.5 min (±28.4) for patients who required a procedure within 1-h compared with 61.6 miles (SD ± 30.9) with an estimated 66.1 min (SD ± 30.8) for the remainder of the cohort (P value 0.899 and 0.680, respectively). CONCLUSIONS This analysis demonstrates that helicopter transport was not necessary for the vast majority of trauma patients transported via helicopter.
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Affiliation(s)
- Chelsea R Horwood
- Department of Trauma and Critical Care, The Ohio State University, Columbus, Ohio
| | - Kevin Ricci
- Department of Trauma and Critical Care, The Ohio State University, Columbus, Ohio
| | - Carly G Sobol
- Department of Trauma and Critical Care, The Ohio State University, Columbus, Ohio
| | - David Evans
- Department of Trauma and Critical Care, The Ohio State University, Columbus, Ohio
| | - Daniel Eiferman
- Department of Trauma and Critical Care, The Ohio State University, Columbus, Ohio.
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Dominguez OH, Grigorian A, Lekawa M, Schubl SD, Chin T, Kim DY, de Virgilio C, Nahmias J. Helicopter Transport Has Decreased Over Time and Transport From Scene or Hospital Matters. Air Med J 2020; 39:283-290. [PMID: 32690305 DOI: 10.1016/j.amj.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Several reports have found helicopter emergency medical services (HEMS) to be associated with a lower risk of mortality compared with ground emergency medical services (GEMS); however, most studies did not control for transport time or stratify interfacility versus scene. We hypothesize that the HEMS transport rate has decreased nationally and that the risk of mortality for HEMS is similar to GEMS when adjusting for transport time and stratifying by scene or interfacility. METHODS The Trauma Quality Improvement Program (2010-2016) was queried for adult patients transported by HEMS or GEMS. Multivariable logistic regression was used. RESULTS The HEMS transport rate decreased by 38.2% from 2010 to 2016 (P < .001). After controlling for known predictors of mortality and transport time, HEMS was associated with a decreased risk of mortality compared with GEMS for adult trauma patient transports (odds ratio = 0.74; 95% confidence interval [CI], 0.71-0.77; P < .001). Compared with GEMS, HEMS transports from the scene were associated with a decreased risk of mortality (OR = 0.63; 95% CI, 0.60-0.66; P < .001), whereas HEMS interfacility transfer was associated with an increased risk of mortality (OR = 1.22; 95% CI, 1.14-1.31; P < .001). CONCLUSION The rate of HEMS transports in trauma has decreased by nearly 40% over the past 7 years. Our results suggest that HEMS use for scene transports is beneficial for the survival of trauma patients.
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Affiliation(s)
- Oscar Hernandez Dominguez
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA.
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Michael Lekawa
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Sebastian D Schubl
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Theresa Chin
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Dennis Y Kim
- Department of Surgery, University of California, Harbor-Los Angeles, Los Angeles, CA
| | - Christian de Virgilio
- Department of Surgery, University of California, Harbor-Los Angeles, Los Angeles, CA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
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