Abe Toshikazu, Takahashi Osamu, Saitoh Daizoh, Tokuda Yasuharu
Crit Care. 2014 Jul 9;18(4):R146. doi: 10.1186/cc13981.
Helicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.
This multicenter prospective observational study involved 24,293 patients. All patients were older than 15 years of age, had sustained blunt or penetrating trauma and had an Injury Severity Score (ISS) higher than 15. All of the patient data were recorded between 2004 and 2011 in the Japan Trauma Data Bank, which includes data from 114 major emergency hospitals in Japan. The primary outcome was survival to discharge from hospitals. The intervention was either transport by helicopter with a physician or ground emergency services.
A total of 2,090 patients in the sample were transported by helicopter, and 22,203 were transported by ground. Overall, 546 patients (26.1%) transported by helicopter died compared to 5,765 patients (26.0%) transported by ground emergency services. Patients transported by helicopter had higher ISSs than those transported by ground. In multivariable logistic regression, helicopter transport had an odds ratio (OR) for survival to discharge of 1.277 (95% confidence interval (CI), 1.049 to 1.556) after adjusting for age, sex, mechanism of injury, type of trauma, initial vital signs (including systolic blood pressure, heart rate and respiratory rate), ISS and prehospital treatment (including intubation, airway protection maneuver and intravenous fluid). In the propensity score-matched cohort, helicopter transport was associated with improved odds of survival compared to ground transport (OR, 1.446; 95% CI, 1.220 to 1.714). In conditional logistic regression, after adjusting for prehospital treatment (including intubation, airway protection maneuver and intravenous fluid), similar positive associations were observed (OR, 1.230; 95% CI, 1.017 to 1.488).
Among patients with major trauma in Japan, transport by helicopter with a physician may be associated with improved survival to hospital discharge compared to ground emergency services after controlling for multiple known confounders.
自2001年起，日本开始提供配备医生的直升机紧急医疗服务（HEMS）。然而，由于直升机服务需要昂贵且有限的资源，HEMS及其对严重创伤患者预后的可能影响一直存在争议。我们的目的是分析配备医生的直升机转运与地面服务的使用和严重创伤成年患者生存率之间的关联。
这项多中心前瞻性观察性研究纳入了24293例患者。所有患者年龄均超过15岁，遭受钝性或穿透性创伤，损伤严重度评分（ISS）高于15分。所有患者数据于2004年至2011年期间记录在日本创伤数据库中，该数据库包含来自日本114家主要急救医院的数据。主要结局是出院存活。干预措施为配备医生的直升机转运或地面紧急服务。
样本中共有2090例患者通过直升机转运，22203例通过地面转运。总体而言，直升机转运的患者中有546例（26.1%）死亡，而地面紧急服务转运的患者中有5765例（26.0%）死亡。直升机转运的患者ISS高于地面转运的患者。在多变量逻辑回归中，在调整年龄、性别、损伤机制、创伤类型、初始生命体征（包括收缩压、心率和呼吸频率）、ISS和院前治疗（包括插管、气道保护措施和静脉输液）后，直升机转运出院存活的比值比（OR）为1.277（95%置信区间（CI），1.049至1.556）。在倾向评分匹配队列中，与地面转运相比，直升机转运与存活几率提高相关（OR，1.446；95%CI，1.220至1.714）。在条件逻辑回归中，在调整院前治疗（包括插管、气道保护措施和静脉输液）后，观察到类似的正相关（OR，1.230；95%CI，1.017至1.488）。
在日本的严重创伤患者中，在控制多个已知混杂因素后，配备医生的直升机转运与地面紧急服务相比，可能与出院存活率提高相关。
