According to a study published in the April 18 issue of JAMA, patients who are airlifted to level I or II trauma centers via helicopter have improved survival than patients transported by ground emergency medical services.
Findings from the study, that included data on over 200,000 adults with serious injuries, were presented by Adil H. Haider, M.D, M.P.H., F.A.C.S., of the Johns Hopkins University School of Medicine, Baltimore, at a JAMA media briefing at the National Press Club.
The researchers explained:
“Trauma remains the leading cause of death and disability among young people around the world. In the United States, more than 50 million people are injured per year, resulting in approximately 169,000 annual deaths and a life-time cost of $406 billion.”
For traumatically injured patients, the use of helicopter emergency medical services (EMS) and its potential impact on outcomes has been the subject of debate.
The researchers write:
“Because helicopter transport is a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground EMS is warranted.”
In order to compare the association between the use of helicopter vs. ground EMS survival among adults with traumatic injuries, Dr. Haider and colleagues conducted a study involving 223,475 patients aged 15+.
All 223,475 patients had an injury severity score that was defined as major trauma, and sustaining blunt or penetrating trauma that required to U.S., level I or II trauma centers.
Data for the patients were documented in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. The measured outcomes included survival to hospital discharge and discharge disposition.
161,566 patients were transported to trauma centers by ground EMS and 61,909 were transported by helicopter. The researchers found that unadjusted mortality was lower for patients transported by ground (n= 17,775; 11%) than those transported by helicopter (n = 7,813; 12.6%, although more patients transferred by helicopter had higher Injury Severity Scores.
After controlling for several known confounders and further analyses the researchers discovered that patients transported via helicopter to level 1 trauma centers were 16% more likely to survive than patients transported via ground EMS (absolute risk reduction, 1.5%). In addition, those transported via helicopter to level II trauma centers were 15% more likely to survive (absolute risk reduction, 1.4%).
The researchers explained:
“Thus, for patients transported to level I trauma centers by helicopter, 65 patients would need to be transported to save 1 life; for patients transported to level II trauma centers, the number needed to treat is 69.”
Furthermore, when considering patient disposition following hospital discharge, the researchers found that injury severity was higher among patients transported via helicopter than patients transported via ground EMS.
47.6% of patients transported via helicopter to level I centers were discharged home without services compared with 57.3% of patients transported via ground EMS. In addition, 18.2% of patients transported by helicopter to level 1 trauma centers were discharged to rehabilitation vs. 12.7% in the ground transport group, and to intermediate facilities (9.3% vs. 6.5%, respectively).
Patients transported to level I trauma centers via ground EMS were more likely than helicopter patients to be discharged to a nursing home.
According to the researchers, which aspect of helicopter transport is responsible for the improved survival remains unknown.
They explain:
“Future studies should investigate specific components of helicopter EMS such as prehospital interventions, total prehospital time, crew configuration, and distance as factors that may in part or whole explain the benefit of helicopter EMS for adults with major trauma because understanding the effectiveness of each may help determine which patients benefit most from this resource.
Future studies should focus on efficient and user-friendly prehospital assessment tools to properly identify injured adults who will be the most likely to benefit from helicopter transport.”
Written By Grace Rattue