Pediatric trauma patients are more likely to be discharged from the emergency department after arrival by helicopter emergency medical services

Knofsky, Meredith L.; Burns, J. Bracken; Chesire, David J.; Tepas, Joseph J.; Kerwin, Andrew J.

doi:10.1097/ta.0b013e31827e19a4

Cited by 30 publications

(24 citation statements)

References 8 publications

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“…HEMS have also been reported as being overused [ 8 , 12 ], sometimes being called for non-severe pediatric patients; therefore, it is not clear whether their effectiveness is only associated with patients with severe trauma. Moreover, HEMS cost more than GEMS [ 13 , 14 ], and staff require in-depth training concerning aviation and medical services [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study

et al. 2020

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Background Helicopter emergency medical services’ (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients. Methods This retrospective cohort study utilized data from the Japan Trauma Data Bank, a national multicenter clinical trauma database. Participants were aged <18 years, admitted between 2004 and 2015, and transported from the scene to the hospital by HEMS or ground emergency medical services (GEMS). We used a standardized mortality ratio (SMR) weight method, and fitted a marginal structural model to adjust for measured confounders. The SMR weight was calculated using the estimation of the propensity scores. A logistic regression model was used with the baseline independent variables to estimate the propensity score. Results Overall, 5,947 patients were identified in our study: 453 were transported by HEMS and 5,494 by GEMS. The mean injury severity score in the HEMS group was significantly higher than that in the GEMS group17.0 (Standard deviation = 11.0) vs 12.2 (Standard deviation = 9.2), p < .001. In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001). After adjusting for covariates, HEMS transport was not associated with reduced hospital mortality. (odds ratio = 0.82, 95% confidence interval = 0.42–1.58). Conclusions HEMS was not associated with reduced mortality among pediatric trauma patients compared with GEMS in this nationwide study. Further investigation is necessary to determine who clearly benefits from HEMS as compared to GEMS.

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Section: Introductionmentioning

confidence: 99%

Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study

et al. 2020

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“…Knofsky et al demonstrated that injured pediatric HEMS patients were both less severely injured and more likely to be discharged from the ED when compared to their adult counterparts. 42 …”

Section: Discussionmentioning

confidence: 99%

Helicopters and injured kids

Brown

Leeper

Sperry

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background Helicopter emergency medical services (HEMS) are frequently used to transport injured children, despite unclear evidence of benefit. The study objective was to evaluate the association of HEMS compared to ground emergency medical services (GEMS) transport with outcomes in a national sample of pediatric trauma patients. Methods Patients age ≤15 undergoing scene transport by HEMS or GEMS in the NTDB 2007-2012 were included. Propensity score matching was used to match HEMS and GEMS patients for likelihood of HEMS transport based on demographics, prehospital physiology and time, injury severity, and geographic region. Absolute standardized differences <0.1 indicated adequate covariate balance between groups after matching. The primary outcome was in-hospital survival, while the secondary outcome was discharge disposition in survivors. Conditional logistic regression determined the association between HEMS versus GEMS transport with outcomes while controlling for demographics, admission physiology, injury severity, non-accidental trauma, and in-hospital complications not accounted for in the propensity score. Subgroup analysis was performed in patients with transport time >15 min to capture patients with the potential for HEMS transport. Results A total of 25,700 HEMS/GEMS pairs were matched from 166,594 patients. Groups were well matched with all propensity score variables having absolute standardized differences <0.1. In matched patients, HEMS was associated with a 72% increase in odds of survival compared to GEMS (AOR 1.72; 95%CI 1.26—2.36, p<0.01). Transport mode was not associated with discharge disposition (p=0.47). Subgroup analysis included 17,657 HEMS/GEMS pairs. HEMS was again associated with a significant increase in odds of survival (AOR 1.81; 95%CI 1.24—2.65, p<0.01), while transport mode was not associated with discharge disposition (p=0.58). Conclusions Scene transport by HEMS was associated with improved odds of survival compared with GEMS in pediatric trauma patients. Further study is warranted to understand the underlying mechanisms and develop specific triage criteria for HEMS transport in this population. Level of Evidence III, therapeutic study

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“…The hospital at which an injured child receives treatment typically has been governed by trauma triage protocols and criteria with high rates of over-triage and under-triage reported internationally [ 11 – 14 ]. In New South Wales (NSW), the study site, the most recent data suggest that less than one-third of severely injured children are initially treated at a Paediatric Trauma Centre (PTC) with a survival benefit between three and six times higher if treatment occurred at a PTC compared to those treated at an Adult Trauma Centre (ATC) [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Paediatric trauma systems and their impact on the health outcomes of severely injured children: protocol for a mixed methods cohort study

Curtis

McCarthy

Mitchell

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundInjury is a leading cause of death and disability for children. Regionalised trauma systems have improved outcomes for severely injured adults, however the impact of adult orientated trauma systems on the outcomes of severely injured children remains unclear. The objective of this study is to review the processes of care and describe the impacts of a regionalised trauma system on the outcomes of severely injured children.MethodsThis article describes the design of a mixed methods cohort study evaluating the paediatric trauma system in New South Wales (NSW), the most populous state in Australia. Recommendations and an implementation strategy will be developed for aspects of the paediatric trauma care system that require change.All injured children (aged <16 years) requiring intensive care, or with an Injury Severity Score (ISS) ≥ 9 treated in NSW, or who died following injury in NSW in the 2015–16 financial year, will be eligible for participation. Injury treatment and processes will be examined via retrospective medical record review. Quality of care will be measured via peer review and staff interviews, utilising a human factors framework. Health service and cost outcomes will be calculated using activity based funding data provided by the Ministry of Health. Health-related quality of life (HRQoL) proxy measures will occur at baseline, 6 and 12 months to measure child HRQoL and functional outcomes.DiscussionThis will be the first comprehensive analysis undertaken in Australia of the processes and systems of care for severe paediatric injury. The collaborative research method will encourage clinician, consumer and clinical networks to lead the clinical reform process and will ultimately enable policy makers and service providers to ensure that children seriously injured in Australia have the best opportunity for survival, improved functional outcome and long-term quality of life.

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Pediatric trauma patients are more likely to be discharged from the emergency department after arrival by helicopter emergency medical services

Abstract: Epidemiologic study, level III.

Cited by 30 publications

References 8 publications

Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study

Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study

Helicopters and injured kids

Paediatric trauma systems and their impact on the health outcomes of severely injured children: protocol for a mixed methods cohort study

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