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How Does Implementing Strict Triage Criteria for Helicopter Transport Affect Outcomes?
Marcelo Cerullo, BA, Sandra R. DiBrito, MD, Seth D. Goldstein, MD, PhD, Susan Ziegfeld, PNP-BC, Dylan Stewart, MD, Isam W. Nasr, MD. Johns Hopkins School of Medicine, Department of Surgery, Division of Pediatric Surgery

Background: Helicopter transport is an expensive yet potentially life-saving measure for trauma patients. This study examines whether the implementation of strict triage criteria affected patient survival in a state that has a centralized Medevac system. A crash in 2008 led to a drastic decrease in helicopter transport due to stricter triage criteria.

Methods: Pediatric trauma patients transported from scene from January 2000 to December 2015 at a Level 1 pediatric trauma center were selected. Propensity score for transport by helicopter was constructed using baseline patient characteristics and linear distance from hospital. The average effect of transport by helicopter on outcomes and mortality was determined using generalized linear models with both weighted and matched subanalyses to calculate a difference-in-differences estimate.

Results: We identified 5,697 patients; 26.0% were transported by helicopter, and 68 (1.2%) died in-hospital. Adequate balance was evidenced by standardized mean differences in pre-treatment variables <0.1. Poisson regression demonstrated no overall effect by air transport on length of stay (p>0.05). Transport by helicopter had a significantly increased odds of mortality overall (odds ratio [OR]=1.29, 95% confidence interval [CI]: 1.15-1.45, p<0.001), however overall net survival benefit for helicopter transport in the post-crash period was improved (OR=0.64, 95% CI: 0.52-0.79; p<0.001).

Conclusions: Helicopter usage has decreased sharply after the implementation of stricter triage criteria. Although pediatric trauma patients transported by helicopter have overall increased odds of death, helicopter transport has translated into increased survival. Given this potential survival advantage, trauma care systems should consider expanded use of helicopter transport.

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