Helicopter Transport of Pediatric Trauma Patients in an Urban Emergency Medical Services System: A Critical Analysis

Eckstein, Marc; Jantos, Thomas; Kelly, Nicole; Cardillo, Anthony B

doi:10.1097/00005373-200208000-00025

Cited by 54 publications

(30 citation statements)

References 21 publications

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“…13,15,16,29,30 They found no overall benefit of HEMS transport for patients injured in areas close to a trauma center. However, they did point out special circumstances where HEMS transport in these areas may be justified, such as events requiring prolonged extrication of the patient or multicasualty events that overwhelm available ground EMS units.…”

Section: Discussionmentioning

confidence: 97%

“…[6][7][8][9][10][11][12][13][14][15][16][17][18] Some of the primary limitations of previous studies are a lack of prehospital data, time and distance data, and adequate balancing of the HEMS-and ground-transported patients with respect to numerous variables related to both the likelihood of HEMS transport and the increased risk of death. Our study tried to address each of these limitations by incorporating time and distance measures and using a propensity score approach, which combined many confounding covariates into a single composite confounder value.…”

Section: Discussionmentioning

confidence: 99%

“…Despite numerous studies of the association of trauma mortality and helicopter transport of trauma patients [6][7][8][9][10][11][12][13][14][15][16][17][18] spanning some 25 years, the topic continues to be the subject of debate. 4,19 The settings, patients, training level of HEMS crews, and study methodologies vary considerably among these studies, making it difficult to compare and generalize results.…”

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confidence: 99%

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Association of Direct Helicopter Versus Ground Transport and In-hospital Mortality in Trauma Patients: A Propensity Score Analysis

Stewart

Cowan

Thompson

et al. 2011

Academic Emergency Medicine

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Objectives: Helicopter emergency medical services (HEMS) transport of trauma patients has been used for decades. Its use, however, is still a subject of debate, including issues such as high costs, increasing numbers of crashes, and conflicting results regarding effectiveness in reducing mortality. The aim of this study was to examine whether mode of transport (HEMS vs. ground EMS) is independently associated with mortality among trauma patients transported directly from the scene of injury to definitive care.Methods: All trauma patients transported directly to a Level I or Level II trauma center by either air or ground EMS over a 4-year period were selected from the Oklahoma State Trauma Registry. Multivariable logistic regression was used to develop propensity scores based on variables measured at the scene of injury. The propensity scores represented the predicted probabilities of a patient being transported by HEMS given a specific set of characteristics and were used as a composite confounding variable in subsequent models of the association of mortality and mode of transport. Along with the propensity scores, Injury Severity Scores (ISS), initial Revised Trauma Score (RTS), and distance from the trauma center were included in a Cox proportional hazards model of the association of mode of transport and 24-hour and 2-week mortality.Results: Overall, the hazard ratio (HR) for 2-week mortality in patients transported by HEMS was 33% lower (HR = 0.67, 95% confidence interval [CI] = 0.54 to 0.84) than in patients transported by ground EMS from the scene of injury, after adjustment for the propensity score and other covariates. In subanalyses, the apparent association of a reduction in the hazard of early mortality among patients transported by HEMS was most evident for patients with an RTS based on injury scene vital signs of 3 to 7 (HR = 0.61, 95% CI = 0.46 to 0.82). The point estimate of the HR was similar (HR = 0.65 95% CI = 0.34 to 1.2) in the 75% of cases who had normal vital signs at the scene of injury, although it was no longer statistically significant because crude mortality was very low (1.7%) in this group. Among those with a RTS of 3 or less at the scene, crude mortality was 58%, and mode of transport was not associated with mortality (HR = 1.02, 95% CI = 0.68 to 1.6).Conclusions: Helicopter EMS transport was associated with a decreased hazard of mortality among certain patients transported from the scene of injury directly to definitive care. Refinements in scene triage and transport guidelines are needed to more effectively select patients that may benefit from HEMS transport from those unlikely to benefit.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Association of Direct Helicopter Versus Ground Transport and In-hospital Mortality in Trauma Patients: A Propensity Score Analysis

Stewart

Cowan

Thompson

et al. 2011

Academic Emergency Medicine

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“…In the United States (US), epidemiological data of children in EMS are well described [9], albeit data from HEMS are limited [16] and most studies only include pediatric trauma patients [17,18]. Comparable data in terms of geography were published by Ummenhofer et al [13] analyzing Swiss HEMS.…”

Section: Discussionmentioning

confidence: 99%

Kindernotfälle in der Luftrettung – eine epidemiologische Studie zur Versorgung in Österreich

Selig

Trimmel

Voelckel

et al. 2011

Wien Klin Wochenschr

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“…A third of the children in their study were discharged directly from the emergency department. 54 After deriving a pediatric overtriage rate of 85% in their retrospective study, Moront et al also expressed concerns regarding pediatric overtriage. 39 Further confounding the analysis of this subject is the disputable time-savings of HEMS.…”

Section: Helicopter Transportation For Patients Meeting Physiologic Amentioning

confidence: 99%

An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

Thomas¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

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Background. Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. Objective. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. Methods. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on

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Helicopter Transport of Pediatric Trauma Patients in an Urban Emergency Medical Services System: A Critical Analysis

Abstract: The majority of pediatric trauma patients transported by helicopter in our study sustained minor injuries. A revised policy to better identify pediatric patients who might benefit from helicopter transport appears to be warranted.

Cited by 54 publications

References 21 publications

Association of Direct Helicopter Versus Ground Transport and In-hospital Mortality in Trauma Patients: A Propensity Score Analysis

Association of Direct Helicopter Versus Ground Transport and In-hospital Mortality in Trauma Patients: A Propensity Score Analysis

Kindernotfälle in der Luftrettung – eine epidemiologische Studie zur Versorgung in Österreich

An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

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