S. K. Madiraju3, J. Catino1, C. Kokaram1, T. Genuit3, M. Bukur2 1Delray Medical Center,Trauma/Critical Care,Delray Beach, FL, USA 2Bellevue Hospital Center,Trauma/Critical Care,New York, NY, USA 3FAU Charles E Schmidt College Of Medicine,N/A,Boca Raton, FL, USA
Introduction: Aeromedical evacuation of trauma patients is a potentially lifesaving intervention targeted to benefit those with severe injuries. Helicopter transport of less severely injured patients is controversial and costly. This study aims to identify the financial costs associated with helicopter evacuation of over triaged patients using a complex trauma activation algorithm at a Level I Trauma Center.
Methods: A 6-year retrospective analysis was conducted (2010-2015) of all Adult Trauma Activations presenting to a Level I Trauma center. Exclusion criteria were patients with non-survivable injuries, missing variables, or those transferred from the Emergency Department (ED). Patients were dichotomized by transportation method as well as trauma activation criteria. Our complex trauma algorithm is loosely based upon CDC criteria and includes Red (physiological), Blue (Mechanistic), and Grey (County/Paramedic Judgement) classifications. Our primary outcome was over triage rate of aeromedical patients defined as those that were discharged from the ED, medically admitted without injuries, or admitted to observation status only. Our secondary outcomes were adjusted mortality rates and total financial costs of unnecessary helicopter use.
Results: During the 6-year period 4,218 patients arrived as Trauma Activations with 28% arriving by Helicopter. Patients arriving by air were more likely to be young males that were uninsured with a penetrating mechanism (15.5% vs. 10%, p<0.001) higher injury burden (Median ISS 8 vs. 6, p<0.001) and need for Operative intervention (17% vs. 13%, p<0.001) than those arriving by ground. Red alerts were the most common (63%) criteria for air transport followed by Blue (31%) and Grey (6%). Over triage (Median ISS 4 [IQR 1-5]) increased significantly from 51% to 77% with lower tier activation criteria (p<0.001). Adjusted mortality between air and ground transport was not significantly different for activation criteria (Red 10.9% vs. 8.5%, Adjusted p=0.548, Blue 3.2% vs. 3.6%, Adjusted p=0.270, Grey 2.7% vs. 0%, Adjusted p=1.000). Median charges for air evacuated patients was $10,478 (IQR $10,387 – $10,661, vs. $800 via ground). By eliminating over triage of air patients, this would result in a cost savings of $3,603,442 annually.
Conclusion: Using a complex trauma activation protocol results in significant over triage (52%) and unnecessary air evacuation of minimally injured patients at great financial cost. Revision of trauma activation protocols may result in more judicious air transport use and subsequent significant reductions in health care costs.