Quality of life following trauma before and after implementation of a physician‐staffed helicopter

Abstract

Background: Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients. Methods: Prospective, observational study including trauma patients who survived at least 3 years after injury. A 5-month period prior to PS-HEMS implementation was compared with the first 12 months after PS-HEMS implementation. QoL was assessed 4.5 years after trauma by the SF-36 questionnaire. Primary endpoint was the Physical Component Summary score. Results: Of the 1994 patients assessed by a trauma team, 1521 were eligible for inclusion in the study. Of these, 566 (37%) gave consent to participate and received a questionnaire by mail, and 402 (71%) of them returned the questionnaire (n = 114 before PS-HEMS; n = 288 after PS-HEMS implementation). Older patients, women and patients with trauma in the after PS-HEMS period were more likely to return the questionnaire. No significant association between QoL and period (before vs. after PS-HEMS) was found; the Physical Component Summary scores were 50.0 and 50.9 in the before and after PS-HEMS periods, respectively (P = 0.47). We also found no difference on multivariable analysis with adjustment for sex, age and injury severity score. Conclusion: No significant difference in QoL among trauma patients was found after implementation of a PS-HEMS.

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

“…They found a slightly worse disability score for patients transported by PS‐HEMS. The two other studies measured quality of life using SF‐36 questionnaire that provides a Physical and Mental Summary score, and using EQ‐5D giving a measurement of health status . No differences between the groups in these two studies were found.…”

“…Studies included in qualitative synthesis (n = 18) prospective, observational studies. Three types of patient categories were reported: 13 studies included trauma patients, [23][24][25][26][27][28][29][30][31][32][33][34][35] 5 studies included cardiac patients transported for primary percutaneous intervention 29,36-39 and 1 study included stroke patients. 40 One study, by Fjaeldstad et al, 29 included both trauma and cardiac patients.…”

“…The primary outcome in the included studies was mortality/survival (n = 9, 50%), 24,[26][27][28]32,33,35,36,40 time to hospital (n = 5) 29,31,37-39 and quality of life (n = 3). 25,30,34 One included randomized controlled trial reported mortality as a secondary outcome, whereas Glasgow Outcome Score was the primary outcome. 23 The presented studies were mainly from Europe (n = 15) and the median study duration time was 22 months [13.25-40] ( Table 1).…”

“…Three studies reported a significant shorter transport time by helicopter transport, 28,29,31 and three studies showed a significant longer time by helicopter transport. 23,26,27 Three studies 25,30,34 reported quality of life. One study 25 reported disability (with assessment of locomotion, dexterity, sensory and mental functioning, incontinence and disfigurement)…”

Trauma outcome research – More is needed

“…A recent paper in Acta Anaesthesiologica Scandinavica examined quality of life in a group of trauma victims 4.5 years after injury 2. In this study, the physical component and the mental component of the SF‐36 questionnaire was employed.…”