Trauma Centre Brabant, St. Elisabeth Hospital, Tilburg, The Netherlands.
Injury. 2012 Sep;43(9):1362-7. doi: 10.1016/j.injury.2012.01.009. Epub 2012 Feb 2.
Object of this study was to evaluate the effect of the Helicopter Emergency Medical Services (HEMS) on trauma patient mortality and the effect of prehospital time on the association between HEMS and mortality.
Trauma patients admitted to a level 1 trauma centre and treated on-scene by the HEMS and Emergency Medical Services (EMS) between 2003 and 2008 were included (n = 186). A control group treated by EMS only (n = 186) was created by matching on ISS, age and severe traumatic brain injury (TBI). Mortality was compared by calculating odds ratios (OR) and numbers needed to treat (NNT), with adjustment for prehospital coded Revised Trauma Score. The effect of prehospital time mortality was tested by a logistic regression. Analyses were made for patients with and without TBI.
The OR of early trauma fatality for the HEMS/EMS versus EMS-only groups was 0.8 for patients both with TBI (95% CI 0.4-1.7; NNT: 22) and without TBI (95% CI 0.2-3.3; NNT: 273). The risk of in-hospital mortality was non-significantly higher for patients with TBI in the HEMS/EMS group (OR = 1.3; 95% CI 0.6-2.7; NNT: -15) compared to the EMS-only group and non-significantly lower for patients without TBI (OR = 0.9; 95% CI 0.3-2.5; NNT: 129). After adjustment for prehospital time, the risk of early trauma fatality for patients with TBI treated by the HEMS decreased (OR = 0.6; 95% CI 0.3-1.6). The risk of in-hospital mortality for these patients decreased from 1.3 to 0.8 (95% CI 0.4-2.0). The effect of the HEMS on patients without TBI did not change after adjustment for prehospital time.
HEMS treatment is associated with a non-significantly higher risk of in-hospital mortality for patients with TBI and a non-significantly lower risk for patients without TBI. This increased risk of mortality in TBI patients is attributable to the increased prehospital time. These results indicate that HEMS does not have a positive impact on survival.
本研究旨在评估直升机紧急医疗服务（HEMS）对创伤患者死亡率的影响，以及院前时间对 HEMS 与死亡率之间关联的影响。
纳入了 2003 年至 2008 年间在一级创伤中心接受 HEMS 和紧急医疗服务（EMS）现场治疗的创伤患者（n = 186）。通过匹配 ISS、年龄和严重创伤性脑损伤（TBI），创建了仅接受 EMS 治疗的对照组（n = 186）。通过计算优势比（OR）和需要治疗的数量（NNT）来比较死亡率，并对院前编码修订创伤评分进行调整。通过逻辑回归测试了院前时间对死亡率的影响。对有和没有 TBI 的患者进行了分析。
对于 TBI 和非 TBI 患者，HEMS/EMS 与 EMS 仅治疗组的早期创伤死亡的 OR 分别为 0.8（95%CI 0.4-1.7；NNT：22）和 0.9（95%CI 0.2-3.3；NNT：273）。与 EMS 仅治疗组相比，TBI 患者的 HEMS/EMS 组的院内死亡率风险显著升高（OR = 1.3；95%CI 0.6-2.7；NNT：-15），而非 TBI 患者的院内死亡率风险显著降低（OR = 0.9；95%CI 0.3-2.5；NNT：129）。在校正院前时间后，TBI 患者接受 HEMS 治疗的早期创伤死亡风险降低（OR = 0.6；95%CI 0.3-1.6）。这些患者的院内死亡率风险从 1.3 降至 0.8（95%CI 0.4-2.0）。在校正院前时间后，HEMS 对无 TBI 患者的影响保持不变。
HEMS 治疗与 TBI 患者的院内死亡率风险显著升高相关，与非 TBI 患者的死亡率风险显著降低相关。TBI 患者的这种死亡率升高归因于院前时间的增加。这些结果表明，HEMS 对生存率没有积极影响。
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