LAC+USC Medical Center, Division of Trauma Surgery and Surgical Critical Care, University of Southern California, 1200 North State Street, IPT, Room C4E100, Los Angeles, CA 90033, USA.
World J Surg. 2009 Nov;33(11):2469-76. doi: 10.1007/s00268-009-0185-1.
The purpose of this study was to investigate the relationship between the method of transport after injury and survival among trauma patients admitted to a Level 1 trauma facility in Los Angeles, California.
The trauma registry of LAC+USC Medical Center was reviewed to identify all injured patients evacuated by emergency medical service (EMS) from the injury scene from 1998 to 2007. The study population was divided into those who were airlifted (HEMS) and those who were transported by ground emergency medical service (GEMS) with transportation time that exceeded 30 minutes (GEMS > 30 minutes).
During the 10-year study period, 1,836 patients were airlifted (helicopters for emergency medical service (HEMS)) and 1,537 patients were ground transported (GEMS > 30 minutes). HEMS patients suffered more frequently a penetrating injury (19% vs. 11%, p < 0.001), presented more often hypotensive to the emergency department (4% vs. 1%, p < 0.001), had more frequently a Glasgow Coma Scale (GCS) < or = 8 (9% vs. 3%, p < 0.001) and required more often an intubation at the injury scene (1.6% vs. 0.4%, p < 0.001). However, the transportation time and the total prehospital time were significantly shorter for airlifted patients. After multivariable analysis, the difference in mortality between the two transport modalities was not significant (adjusted odds ratio (95% confidence interval, 0.72 (0.22, 2.35); p = 0.596).
In a metropolitan Los Angeles trauma system, EMS helicopter transportation of injured patients does not appear to improve overall adjusted survival after injury. There is however a potential benefit for severely injured subgroups of patients due to the shorter prehospital times.
本研究旨在探讨加利福尼亚州洛杉矶一级创伤中心收治的创伤患者的受伤后转运方式与生存之间的关系。
回顾 LAC+USC 医疗中心的创伤登记处，以确定 1998 年至 2007 年间由紧急医疗服务（EMS）从伤处疏散的所有受伤患者。研究人群分为空运（HEMS）和地面紧急医疗服务（GEMS）转运时间超过 30 分钟（GEMS > 30 分钟）的患者。
在 10 年的研究期间，1836 名患者空运（直升机紧急医疗服务（HEMS）），1537 名患者地面转运（GEMS > 30 分钟）。HEMS 患者更频繁地遭受穿透性损伤（19%比 11%，p < 0.001），更频繁地出现低血压到急诊室（4%比 1%，p < 0.001），更频繁地出现格拉斯哥昏迷量表（GCS）<或= 8（9%比 3%，p < 0.001），更频繁地需要在创伤现场进行插管（1.6%比 0.4%，p < 0.001）。然而，空运患者的转运时间和总院前时间明显更短。多变量分析后，两种转运方式的死亡率差异无统计学意义（校正比值比（95%置信区间），0.72（0.22，2.35）；p = 0.596）。
在洛杉矶大都市创伤系统中，EMS 直升机运送受伤患者似乎不会改善受伤后的总体调整生存。由于院前时间较短，严重受伤亚组患者可能会有潜在的获益。
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