Frequent Flyers? Ground Transport Versus Air Transport in Pediatric Trauma in North Carolina
Nicklaus P. Ashburn, MD1; Andrew B. Starnes, MD, MPH1; Christopher J. McLouth, MS1; Sharon Schiro, PhD2; John K. Petty, MD1; Brian C. Hiestand, MD, MPH1; Henderson D. McGinnis, MD1; Jason P. Stopyra, MD1
1Wake Forest School of Medicine, Winston-Salem, NC; 2NC Office of Emergency Medical Services, Chapel Hill, NC
Background: Choosing between helicopter EMS (HEMS) or ground EMS (GEMS) transport is a common prehospital dilemma. No evidence-based guideline assists in selecting transport modality for pediatric trauma.1,2 Previous research has not conclusively established a HEMS survival benefit.1,2 The objective of this study was to evaluate prehospital transport outcomes for injured children in North Carolina (NC).
Methods: This retrospective cohort analysis used the NC Trauma Registry to identify blunt and penetrating trauma patients under 16 years old who presented to NC Level I Trauma Centers directly from the scene by HEMS or GEMS between 2013 and 2017. Demographics, transport method, Injury Severity Score (ISS), distance from trauma center, and survival were assessed.
Results: 3186 patients were included, with 12.3% (n=393) transported by HEMS. Severe injury (ISS>24) accounted for 13.2% of HEMS and 3.3% of GEMS use (p<0.0001). Minor injury (ISS<9) accounted for 43.2% of HEMS and 70.1% of GEMS use (p<0.0001). Unadjusted mortality was 4.8% (n=19) for HEMS and 2.4% (n=66) for GEMS patients (p=0.0035). Logistic regression controlling for injury mechanism, ISS, age, race, sex, and distance from trauma center determined that HEMS was not associated with improved survival over GEMS (OR 1.23, CI95 0.41-3.65).
Conclusion: HEMS did not confer a mortality benefit in pediatric trauma. Additionally, nearly half of HEMS patients had minor injuries. Further investigation is needed to determine the appropriate role of HEMS in prehospital pediatric trauma management.
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