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Helicopters and Injured Kids: Improved Survival with Scene Air Medical Transport in the Pediatric Trauma Population
Joshua B. Brown, MD, MSc, Christine M. Leeper, MD, Jason L. Sperry, MD, MPH, Andrew B. Peitzman, MD, Timothy R. Billiar, MD, Barbara A. Gaines, MD and Mark L. Gestring, MD, University of Pittsburgh, Pittsburgh PA

Abstract: Background: Helicopter emergency medical services (HEMS) are frequently used to transport injured children, despite unclear evidence of benefit. Our objective was to evaluate the effect of HEMS compared to ground emergency medical services (GEMS) transport on survival. 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, geographic region, and injury severity. Absolute standardized differences >0.1 were considered imbalance between groups after matching. Conditional logistic regression determined the association between HEMS versus GEMS transport with in-hospital survival controlling for demographics, admission physiology, injury severity, non-accidental trauma, and in-hospital complications not accounted for in the propensity score. Results: 25,705 HEMS/GEMS pairs were matched. Groups were well matched with all propensity score variables having absolute standardized differences <0.1. Table 1 compares groups. HEMS patients had higher admission HR, ICU admission and mechanical ventilation rates. Regression demonstrated matched HEMS patients had a 76% increase in odds of survival compared to GEMS patients (AOR 1.76; 95%CI 1.32—2.35, p<0.01) with a NNT of 39 (95%CI 29—71). Conclusions: Injured pediatric patients undergoing scene transport by HEMS had improved odds of survival compared with GEMS nationally. Further study is warranted to develop specific triage criteria for HEMS transport in this population.

Figures:

TABLE 1

HEMS

N=25,705

GEMS

N=25,705

Standardized Difference

p value

Age [years, med (IQR)]

10 (5, 14)

10 (5, 14)

-0.004

0.43

Mechanism (% blunt)

96.0

95.8

0.014

0.15

ISS [med (IQR)]

9 (5, 17)

9 (4, 17)

-0.006

0.39

In-hospital survival (%)

95.7

93.9

0.079

<0.01

 

Objective: At the end of this presentation, the learner will be able to discuss the potential benefits of helicopter compared to ground transport of injured children at the national level.

Objective Content: In a national data set, children transported by helicopter from the scene of injury had improved odds of survival to discharge compared to those transported by ground ambulance after being matched for the likelihood of helicopter transport.


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