Comparison of Helicopter and Ground Transportation in Pediatric Trauma Patients

Abstract

INTRODUCTION: Geographic and population diversity remains an issue in appropriate triage of helicopter emergency medical services (HEMS). Longer transport times in ground emergency medical services and HEMS are well-known to be associated with increased mortality. The over-triage of minor injuries to HEMS transport raises issues of cost-effectiveness. We hypothesize that HEMS transport is associated with decreased mortality and increased likelihood of discharge home without need for medical services. METHODS: This was a retrospective study of pediatric (younger than 18 years) trauma patients transported by HEMS or ground emergency medical services that were reported to the National Trauma Data Bank from 2007 to 2015. In-hospital mortality was the primary outcome, and discharge without the need for medical services was the secondary outcomes. Logistic regression models were used with and without propensity matching for demographic and injury-specific factors. RESULTS: There were 348,107 patients identified from the National Trauma Data Bank. After propensity matching, 21.9% of ground emergency medical services cases and 96.0% of HEMS cases were analyzed (Figure). Multivariate regression analysis showed lower odds of mortality in the HEMS group (odds ratio 0.69 [95% CI 0.64 to 0.75], p < 0.01) and increased odds of discharge home without services (odds ratio 1.29 [95% CI 1.22 to 1.41], p < 0.01).Figure.: EMS, emergency medical services; GEMS, ground medical emergency services; HEMS, helicopter emergency medical services.CONCLUSION: Appropriate triage remains an important clinical issue requiring ongoing investigation. We showed that pediatric patients transported by HEMS had decreased odds of mortality and increased odds of discharge home without services. Further research is needed to identify specific factors that may influence these results such as access to home services, insurance status, transport times, and indications for HEMS transport.