C. R. Horwood1, C. G. Sobol1, D. Evans1, D. Eiferman1 1The Ohio State University,Departemnt Of Trauma And Critical Care,Columbus, OH, USA
Introduction: On average, helicopter transport is $6,000 more compared to ground transportation of a trauma patient. Air transport has the theoretical advantage of allowing patients to receive injury treatment more promptly. However, there are no defined criteria for which patients require expedited transport. The primary study objective is to evaluate the appropriateness of helicopter transport determined by operative care within 1-hour of transfer at an urban level 1 trauma center.
Methods: All trauma patients transported by helicopter from January 2015-December 2017 to an urban level 1 trauma center from referring hospitals or the scene were retrospectively analyzed. The entire cohort was reviewed for level of trauma activation, disposition from trauma bay, median time to procedure. A subgroup analysis was performed evaluating patients that required a procedure within 1-hour of transport compared to the remainder of the patient cohort who were transported via helicopter. Data was analyzed using summary statistics, chi-square test and Mann-Whitney test when appropriate.
Results: A total of 1,590 patients were transported by helicopter. Only 32% (n=507) were level 1 activations, 60% (n=962) were level 2 activations and 8% (n=121) were not a trauma activation upon arrival. 39% percent of patients (n=612) were admitted directly to the floor from the trauma bay and 16% (n=249) of patients required only observation or were discharged home after helicopter transfer. Roughly 1/3 of the entire study cohort (36%, n=572) required any procedure, with a median time to procedure of 31.5 hours (IQR 54.4). Of which, 13% (n= 74) required a procedure within 1-hour of helicopter transport. There was a significant difference in median ISS score for patients who required a procedure within 1- hour of transport (median 22, IQR=27) vs remainder of cohort transported via helicopter (median 9, IQR=12) (p-value<0.001). The average distance (in miles) if the patient had been driven by ground transport rather than helicopter was 67.0 miles (SD±27.9) and would take an estimated 71.5 minutes (±28.4) for patients who required a procedure within 1-hour compared to 61.6 miles (SD±30.9) with an estimated 66.1 minutes (SD±30.8) for the remainder of the cohort (p-value=0.899 and p-value=0.680 respectively). In the group who required a procedure within 1- hour 24.3% of patients had a penetrating injury compared to 6.4% for the remainder of the cohort (p-value<0.001).
Conclusion: This analysis demonstrates that helicopter transport was not necessary for the vast majority of trauma patients as they did not meet Level 1 trauma activation and did not require emergent interventions to treat injuries. However, there was a significant difference in ISS and type of injury for patients who required a procedure within one hour of transport. Stricter selection is necessary to determine which patients should be transported by helicopter.