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It's All About Location, Location, Location: A New Perspective on Trauma Transport
Document Type
Journal ArticlePublication Date
2016-02-01Keywords
AdolescentAdult
Aged
Aged, 80 and over
*Air Ambulances
Female
*Health Services Accessibility
Humans
Injury Severity Score
Logistic Models
Male
Massachusetts
Middle Aged
Registries
Retrospective Studies
Wounds and Injuries
Young Adult
UMCCTS funding
Emergency Medicine
Health and Medical Administration
Health Services Administration
Health Services Research
Surgery
Translational Medical Research
Trauma
Metadata
Show full item recordAbstract
OBJECTIVE: To determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors. BACKGROUND: The existing literature on the mortality benefit of aeromedical transport on trauma mortality is controversial. Studies examining patient and injury characteristics find higher mortality, whereas studies measuring injury severity find a protective effect. Previous studies have not adjusted for the time and distance that would have been traveled had a helicopter not been used. METHODS: Retrospective analysis of an institutional trauma registry. We compared mortality among adult patients ( > /=15 years) transported from the scene of injury to our level I trauma center by air or ground (January 1, 2000-December 31, 2010) using univariate comparisons and multivariable logistic regression. Regression models were constructed to incrementally account for patient demographics and injury mechanism, followed by injury severity, and, finally, by network bands for drive time and roadway distance as predicted by geographic information systems. RESULTS: Of 4522 eligible patients, 1583 (35%) were transported by air. Patients transported by air had higher unadjusted mortality (4.1% vs 1.9%, P < 0.05). In multivariable modeling, including patient demographics and type of injury, helicopter transport predicted higher mortality than ground transport (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-4.0). After adding validated injury severity measures to the model, helicopter transport predicted lower mortality (OR 0.7, 95% CI 0.3-0.9). Finally, including geographic covariates found that helicopter transport was not associated with mortality (OR 1.1, 95% CI 0.6-2.3). CONCLUSIONS: Helicopter transport does not impart a survival benefit for trauma patients when geographic considerations are taken into account.Source
Ann Surg. 2016 Feb;263(2):413-8. doi: 10.1097/SLA.0000000000001265. Link to article on publisher's siteDOI
10.1097/SLA.0000000000001265Permanent Link to this Item
http://hdl.handle.net/20.500.14038/50503PubMed ID
26079917Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/SLA.0000000000001265