Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan

Abe, Toshikazu; Takahashi, Osamu; Saitoh, Daizoh; Tokuda, Yasuharu

doi:10.1186/cc13981

Cited by 79 publications

(73 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…E1 on GCS equals three-digit code on Japan Coma Scale (JCS) signifying that they were not arousable even with forceful stimulation. Because the JCS in the prehospital setting must be scored and recorded on the JTDB sheet, we used JCS to evaluate consciousness levels in the prehospital setting [9]. Assessment of consciousness levels based on the JCS are useful predictors of outcome in stroke patients [10].…”

Section: Methodsmentioning

confidence: 99%

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Yumoto

Mitsuhashi

Yamakawa

et al. 2016

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

BackgroundCushing’s reflex usually results from intracranial hypertension. Although Cushing’s sign can implicate severe traumatic brain injury (TBI) in injured patients, no major investigations have been made. The purpose of this study was to assess the predictability of life-threatening brain injury requiring immediate neurosurgical intervention (LT-BI) among trauma patients with Cushing’s sign in the prehospital setting.MethodsThis was a retrospective study using data from the Japan Trauma Data Bank from the period of 2010 to 2014. Patients 16 years old or older with blunt mechanisms of injury who were transported directly from the scene and Glasgow Coma Scale for eye opening of one in the prehospital setting were included. LT-BI was defined as patients requiring burr hole evacuation or craniotomy within 24 h of hospital arrival and patients who were non-survivors due to isolated severe TBI. Prehospital systolic blood pressure (pSBP) and heart rate (pHR) were assessed using area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis to predict LT-BI.ResultsOf 6332 eligible patients, 1859 (29%) exhibited LT-BI. AUROC of LT-BI using pSBP and pHR was 0.666 (95% confidence interval (CI); 0.652–0.681, P < 0.001), and 0.578 (95% CI; 0.563–0.594, P < 0.001), respectively. AUROC of pSBP was the highest among the 60 ≤ pHR ≤ 99 subgroup, of which AUROC was 0.680 (95% CI; 0.662–0.699, P < 0.001).Multiple logistic regression analysis showed that the higher the pSBP and the lower the pHR, the more likely that the patients had LT-BI. In a group with pSBP ≥ 180 mmHg and pHR ≤ 59 beats/min, the odds ratio and 95% CI of LT-BI after adjusting for age, sex, and severity of injuries to other body regions was 4.77 (2.85–7.97), P < 0.001 was compared with the reference group, which was defined as patients with normal vital signs.DiscussionOur study has found that the combination of hypertension and bradycardia, which are the components of Cushing's sign without eye opening in the prehospital setting was a weak but a significant predictor of LT-BI, or death due to possible isolated severe TBI.ConclusionsPrehospital Cushing’s sign with disturbed level of consciousness in trauma patients was a weak but significant predictor of the need for immediate neurosurgical intervention.

show abstract

Section: Methodsmentioning

confidence: 99%

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Yumoto

Mitsuhashi

Yamakawa

et al. 2016

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…The 17% represents the maximum effect of PS‐HEMS, which was significant, the 11% the minimum effect, which did not reach significance . The two remaining studies reporting in‐hospital mortality did not find a significant difference between the two groups …”

Section: Resultsmentioning

confidence: 93%

“…Overall, minor differences were found in patient characteristics between the PS‐HEMS and GEMS groups (Table ). One study reported a significantly higher age in the PS‐HEMS group, whereas two studies reported significantly lower age . Distance from scene to hospital was only reported in four studies of which two studies found a significantly longer distance in the PS‐HEMS group compared with GEMS (110 vs 77 km and 97 vs 63 km, both P < .01).…”

Section: Resultsmentioning

confidence: 99%

“…In‐hospital mortality was reported in five studies . Two studies showed significant reduction in in‐hospital mortality in the PS‐HEMS group compared with GEMS with odds ratios (OR) of 0.29 [0.10‐0.82] and 0.21 [0.06‐0.73] .…”

Section: Resultsmentioning

confidence: 99%

“…Six studies had the lowest risk of bias (Newcastle Ottawa Scale 9) . All studies had mortality/survival as primary outcome.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Physician‐staffed Helicopters on Pre‐hospital Patient Outcomes: A systematic review

Risgaard

Draegert

Baekgaard

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background Management of pre‐hospital patients remains a challenge. In developed countries a physician‐staffed helicopter emergency medical service (PS‐HEMS) is used in addition to ground emergency medical service (GEMS), but the effect is debated. This systematic review aimed to evaluate the effect of PS‐HEMS compared with GEMS on patient outcomes based on the published scientific literature. Methods Medline, EMBASE and the Cochrane Library were systematically searched on November 15, 2019 for prospective, interventional studies comparing outcomes of patients transported by either PS‐HEMS or GEMS. Outcomes of interest were mortality, time to hospital and quality of life. Results The majority of 18 studies included were observational and difficult to summarize because of heterogeneity. Meta‐analysis could not be carried out. Three studies found reduced mortality in patients transported by PS‐HEMS compared with GEMS with Odds ratios (OR) of 0.68 (0.47‐0.98); 0.29 (0.10‐0.82) and 0.21 (0.06‐0.73) respectively. Another two studies found improved survival with OR 1.2 (1.0‐1.5) and 6.9 (1.48‐32.5) in patients transported by PS‐HEMS compared with GEMS. In three studies, PS‐HEMS was associated with shorter time to hospital. Three studies reported quality of life and found no benefit of PS‐HEMS. Conclusion In this systematic review the studies comparing PS‐HEMS with GEMS were difficult to summarize because of heterogeneity. We found a possible survival benefit of PS‐HEMS but were unable to conduct a meta‐analysis. The overall quality of evidence was low.

show abstract

Helicopter emergency medical services for adults with major trauma

Galvagno

Sikorski

Hirshon

et al. 2015

Cochrane Database of Systematic Reviews

100

View full text Add to dashboard Cite

show abstract

Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan

Cited by 79 publications

References 15 publications

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Impact of Physician‐staffed Helicopters on Pre‐hospital Patient Outcomes: A systematic review

Helicopter emergency medical services for adults with major trauma

Contact Info

Product

Resources

About