J. W. Greer1, K. W. Sexton1 1University Of Arkansas For Medical Sciences,Little Rock, AR, USA
Introduction:
Patients with penetrating trauma often have significant blood loss and may need temporizing measures before definitive care is delivered. This raised the question of whether or not these patients should be taken to a local emergency department or flown to the states only Level I trauma center for definitive care. Since distance traveled can be significant for some patients in a rural state, we sought to evaluate the safety of helicopter transport of penetrating trauma in a rural state with a single Level I trauma center.
Methods:
We conducted a retrospective review of prospectively collected data from 2009-2015 of all patients in the Arkansas Trauma Database. Variables included: age, gender, mechanism of injury, time to scene, scene time, transport time, dispatch to hospital arrival time, discharge status, ISS (Injury Severity Score), NISS (New Injury Severity Score), TRISS (Trauma and Injury Severity Score), scene GCS (Glasgow Coma Scale), and scene hemodynamics. Descriptive statistics were performed using t-tests and chi-square tests. The data was also analyzed using a multivariate logistic regression with discharge status as the outcome variable.
Results:
During the study period 945 patients were transported by helicopter. Survivors were younger (42 + 16 years vs 51 + 22 years, p<0.001), had a higher TRISS (0.921 + 0.17 vs 0.5 + 0.33, p<0.001), and a GCS ≥ 12 (0.78 vs 0.32, p<0.001). There was no difference in time from helicopter dispatch to hospital arrival (53 + 22 minutes vs 49 + 20 minutes, p =0.08) in these groups. The results of the multivariate logistic regression indicate that mechanism of injury has no significant effect on patient discharge status. Age was found to significantly increase the likelihood of mortality, while TRISS and mild GCS was found to have a significant decrease in the likelihood of mortality, when controlled for other characteristics.
Conclusion:
When controlling for age, gender, TRISS, year of injury, time of hospital arrival (day shift vs night shift), and GCS, penetrating trauma did not impact risk of death. It is safe to fly penetrating trauma in a rural state. Further work needs to be done to determine risk factors of mortality as related to mechanism of injury during helicopter transport.
