Outcomes and Overuse of Direct Air Ambulance Transport for Pediatric Trauma in Oklahoma
Andrew Starnes, MD, MPH1; Nicklaus Ashburn, MD1; Curtis Knoles, MD2; Boyd Burns, DO3; Kenneth Stewart, PhD4
1Wake Forest School of Medicine, Winston-Salem, NC; 2University of Oklahoma, Oklahoma City, OK; 3University of Oklahoma School of Medicine, Tulsa, OK; 4Oklahoma State Department of Health, Oklahoma City, OK
Background: Trauma is the leading cause of emergency medical services (EMS) transport for pediatrics.1 Half the pediatric population in the United States lives over 50 miles from a Level I or II Trauma Center.2 We compared outcome differences between direct ground (GEMS) and helicopter (HEMS) transport of pediatric trauma patients in Oklahoma.
Methods: Patients were identified in the Oklahoma State Trauma Registry as less than 18 years old who received direct transport from the scene of injury to an Oklahoma Level I or II Trauma Center between 2005 and 2014. Univariate analysis was used to compare patient demographics, injury type, Injury Severity Score (ISS), and outcomes. Impact of transport mode on in-hospital mortality was calculated by Cox regression analysis.
Results: Of 4797 patients in the study group, 25.0% were transported by HEMS. Injury severity was greater for HEMS. Mortality prior to ED discharge was nearly the same (2.9% GEMS vs 2.7 HEMS). However, overall mortality was higher for HEMS (8.7% vs 6.5). Minor injury (ISS <15) was observed in 49.9% of HEMS patients. When controlling for injury severity, age, and trauma type, the protective effect of HEMS transport on in-hospital mortality was not statistically significant (Hazard Ratio 0.79 [95% CI 0.62-1.01]).
Conclusion: Patients transported by HEMS more often had severe injuries and worse outcomes. Nearly half of HEMS transports were for categorically mild injuries. The protective effect of HEMS transport on in-hospital mortality was not statistically significant. These findings suggest that HEMS transport is currently being overutilized.
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