Abstract
BackgroundHelicopter emergency medical services’ (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients.MethodsThis retrospective cohort study utilized data from the Japan Trauma Data Bank, a national multicenter clinical trauma database. Participants were aged <18 years, admitted between 2004 and 2015, and transported from the scene to the hospital by HEMS or ground emergency medical services (GEMS). We used a standardized mortality ratio (SMR) weight method, and fitted a marginal structural model to adjust for measured confounders. The SMR weight was calculated using the estimation of the propensity scores. A logistic regression model was used with the baseline independent variables to estimate the propensity score.ResultsOverall, 5,947 patients were identified in our study: 453 were transported by HEMS and 5,494 by GEMS. The mean injury severity score in the HEMS group was significantly higher than that in the GEMS group17.0 (Standard deviation = 11.0) vs 12.2 (Standard deviation = 9.2), p < .001. In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001). After adjusting for covariates, HEMS transport was not associated with reduced hospital mortality. (odds ratio = 0.82, 95% confidence interval = 0.42–1.58).ConclusionsHEMS was not associated with reduced mortality among pediatric trauma patients compared with GEMS in this nationwide study. Further investigation is necessary to determine who clearly benefits from HEMS as compared to GEMS.
Highlights
Helicopter emergency medical services (HEMS) are an integral part of the emergency medical transport system
5,947 patients were identified in our study: 453 were transported by Helicopter emergency medical services’ (HEMS) and 5,494 by ground emergency medical services (GEMS)
In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001)
Summary
Helicopter emergency medical services (HEMS) are an integral part of the emergency medical transport system. A systematic review in 2015 concluded that, compared to ground emergency medical services (GEMS), HEMS were not related to a reduction in adult patient mortality rates [1]. Following the report’s publication, some studies noted that, compared to GEMS, HEMS were more highly associated with reducing mortality rates in adult trauma patients [2,3,4,5]. In the 2015 systematic review, subgroup analyses suggested that HEMS might be associated with reducing mortality in studies that adjusted appropriately for confounders. Helicopter emergency medical services’ (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients
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