Shaw Joshua J, Psoinos Charles M, Santry Heena P
*Department of Surgery University of Massachusetts Medical School, Worcester, MA †Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
Ann Surg. 2016 Feb;263(2):413-8. doi: 10.1097/SLA.0000000000001265.
To determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors.
The existing literature on the mortality benefit of aeromedical transport on trauma mortality is controversial. Studies examining patient and injury characteristics find higher mortality, whereas studies measuring injury severity find a protective effect. Previous studies have not adjusted for the time and distance that would have been traveled had a helicopter not been used.
Retrospective analysis of an institutional trauma registry. We compared mortality among adult patients (≥15 years) transported from the scene of injury to our level I trauma center by air or ground (January 1, 2000-December 31, 2010) using univariate comparisons and multivariable logistic regression. Regression models were constructed to incrementally account for patient demographics and injury mechanism, followed by injury severity, and, finally, by network bands for drive time and roadway distance as predicted by geographic information systems.
Of 4522 eligible patients, 1583 (35%) were transported by air. Patients transported by air had higher unadjusted mortality (4.1% vs 1.9%, P < 0.05). In multivariable modeling, including patient demographics and type of injury, helicopter transport predicted higher mortality than ground transport (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-4.0). After adding validated injury severity measures to the model, helicopter transport predicted lower mortality (OR 0.7, 95% CI 0.3-0.9). Finally, including geographic covariates found that helicopter transport was not associated with mortality (OR 1.1, 95% CI 0.6-2.3).
Helicopter transport does not impart a survival benefit for trauma patients when geographic considerations are taken into account.
在考虑地理因素的情况下，确定航空医疗转运对创伤死亡率的影响。
关于航空医疗转运对创伤死亡率的益处，现有文献存在争议。研究患者和损伤特征的研究发现死亡率较高，而测量损伤严重程度的研究则发现有保护作用。以往的研究没有对如果不使用直升机本来需要行驶的时间和距离进行调整。
对机构创伤登记处进行回顾性分析。我们使用单变量比较和多变量逻辑回归，比较了2000年1月1日至2010年12月31日期间从受伤现场通过空中或地面转运至我们的一级创伤中心的成年患者（≥15岁）的死亡率。构建回归模型以逐步考虑患者人口统计学和损伤机制，其次是损伤严重程度，最后是地理信息系统预测的驾驶时间和道路距离的网络频段。
在4522名符合条件的患者中，1583名（35%）通过空中转运。未经调整的情况下，空中转运的患者死亡率较高（4.1%对1.9%，P<0.05）。在多变量建模中，包括患者人口统计学和损伤类型，直升机转运预测的死亡率高于地面转运（优势比[OR]2.4，95%置信区间[CI]1.2 - 4.0）。在模型中加入经过验证的损伤严重程度测量指标后，直升机转运预测的死亡率较低（OR 0.7，95%CI 0.3 - 0.9）。最后，纳入地理协变量发现直升机转运与死亡率无关（OR 1.1，95%CI 0.6 - 2.3）。
考虑地理因素时，直升机转运对创伤患者没有生存益处。
