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COMPARATIVE STUDY
JOURNAL ARTICLE

Association between helicopter vs ground emergency medical services and survival for adults with major trauma

Samuel M Galvagno, Elliott R Haut, S Nabeel Zafar, Michael G Millin, David T Efron, George J Koenig, Susan P Baker, Stephen M Bowman, Peter J Pronovost, Adil H Haider
JAMA: the Journal of the American Medical Association 2012 April 18, 307 (15): 1602-10
22511688

CONTEXT: Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted.

OBJECTIVE: To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study involving 223,475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank.

INTERVENTIONS: Transport by helicopter or ground emergency services to level I or level II trauma centers.

MAIN OUTCOME MEASURES: Survival to hospital discharge and discharge disposition.

RESULTS: A total of 61,909 patients were transported by helicopter and 161,566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17,775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score-matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14-1.17; P < .001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13-1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001).

CONCLUSION: Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders.

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