TITLE:
The coast and benefits of helicopter emergency medical services instead of the ground unit in traumatic patients: A cost-effectiveness analysis
AUTHORS:
Amin Shams Akhtari, Naghmeh Sadat Jafari, Hamid Kariman, Afshin Amini, Vahid Monsef, Mohamad Noorizadeh, Neda Gholizadeh
KEYWORDS:
Emergency; Traumatic Patients; Aero Medical
JOURNAL NAME:
Health,
Vol.5 No.5,
May
27,
2013
ABSTRACT:
Study objective: Aero medical crews offer
an advanced level of practice and rapid transport to definitive care;
however, their efficacy remains unproven. Previous studies have used relatively
small sample sizes or have been unable to adequately control the effect
of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury. Methods: This was a
cross-sectional study using our county trauma registry.
All patients with trauma injury, who referred to our emergency department by
helicopter or car, were included. The impact of aeromedical response was determined
using logistic regression, adjusting for age, sex, mechanism, preadmissionGlasgowComa Scale score andInjury Severity Score. Finally, the aeromedical patients undergoing field intubation
were compared with ground patients undergoing emergency department (ED)
intubation. Results: A total of 243 patients meeting all
inclusion and exclusion criteria and with complete data sets were identified.
Overall mortality was 25% in the air- and ground-transported cohorts, but outcomes
were not significantly better for the aeromedical patients when adjusted for
age, sex, mechanism of injury, hypotension, Glasgow Coma Scale score, head
Abbreviated Injury Score, and Injury Severity Score (adjusted odds ratio [OR]
1.90; 95% confidence interval [CI] 1.60 to 2.25; P: 0001). Good outcomes
(discharge to home, jail, psychiatric facility, rehabilitation, or leaving against medical advice) were also higher in aeromedical patients (adjusted OR 1.36;
95% CI 1.18 to 1.58; P: 0001). Conclusion: Here we analyze a large database of
patients with moderate to severe traumatic brain injury. Aeromedical response appears to yield no significantly improved outcomes
after adjustment for multiple influential factors in patients with moderate to
severe traumatic brain injury.