Brown Joshua B, Stassen Nicole A, Bankey Paul E, Sangosanya Ayodele T, Cheng Julius D, Gestring Mark L
Department of Surgery, University of Rochester School of Medicine, Rochester, New York 14642-8410, USA.
J Trauma. 2010 Nov;69(5):1030-4; discussion 1034-6. doi: 10.1097/TA.0b013e3181f6f450.
The role of helicopter transport (HT) in civilian trauma care remains controversial. The objective of this study was to compare patient outcomes after transport from the scene of injury by HT and ground transport using a national patient sample.
Patients transported from the scene of injury by HT or ground transport in 2007 were identified using the National Trauma Databank version 8. Injury severity, utilization of hospital resources, and outcomes were compared. Stepwise logistic regression was used to determine whether transport modality was a predictor of survival or discharge to home after adjusting for covariates.
There were 258,387 patients transported by helicopter (16%) or ground (84%). Mean Injury Severity Score was higher in HT patients (15.9 ± 12.3 vs. 10.2 ± 9.5, p < 0.01), as was the percentage of patients with Injury Severity Score >15 (42.6% vs. 20.8%; odds ratio [OR], 2.83; 95% confidence interval [CI], 2.76-2.89). HT patients had higher rates of intensive care unit admission (43.5% vs. 22.9%; OR, 2.58; 95% CI, 2.53-2.64) and mechanical ventilation (20.8% vs. 7.4%; OR, 3.30; 95% CI, 3.21-3.40). HT was a predictor of survival (OR, 1.22; 95% CI, 1.17-1.27) and discharge to home (OR, 1.05; 95% CI, 1.02-1.07) after adjustment for covariates.
Trauma patients transported by helicopter were more severely injured, had longer transport times, and required more hospital resources than those transported by ground. Despite this, HT patients were more likely to survive and were more likely to be discharged home after treatment when compared with those transported by ground. Despite concerns regarding helicopter utilization in the civilian setting, this study shows that HT has merit and impacts outcome.
直升机转运（HT）在民用创伤救治中的作用仍存在争议。本研究的目的是使用全国患者样本比较通过直升机转运和地面转运从受伤现场转运后的患者结局。
使用第8版国家创伤数据库识别2007年通过直升机或地面转运从受伤现场转运的患者。比较损伤严重程度、医院资源利用情况和结局。采用逐步逻辑回归确定在调整协变量后转运方式是否是生存或出院回家的预测因素。
有258,387名患者通过直升机（16%）或地面（84%）转运。直升机转运患者的平均损伤严重度评分更高（15.9±12.3对10.2±9.5，p<0.01），损伤严重度评分>15的患者百分比也是如此（42.6%对20.8%；比值比[OR]，2.83；95%置信区间[CI]，2.76 - 2.89）。直升机转运患者的重症监护病房入住率更高（43.5%对22.9%；OR，2.58；95%CI，2.53 - 2.64）和机械通气率更高（20.8%对7.4%；OR，3.30；95%CI，3.21 - 3.40）。在调整协变量后，直升机转运是生存（OR，1.22；95%CI，1.17 - 1.27）和出院回家（OR，1.05；95%CI，1.02 - 1.07）的预测因素。
与地面转运的创伤患者相比，直升机转运的创伤患者受伤更严重，转运时间更长，需要更多的医院资源。尽管如此，与地面转运的患者相比，直升机转运的患者更有可能存活，并且在治疗后更有可能出院回家。尽管对民用环境中直升机的使用存在担忧，但本研究表明直升机转运有其价值并影响结局。
