Brown Joshua B, Gestring Mark L, Stassen Nicole A, Forsythe Raquel M, Billiar Timothy R, Peitzman Andrew B, Sperry Jason L
*Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA †Division of Acute Care Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Ann Surg. 2016 Feb;263(2):406-12. doi: 10.1097/SLA.0000000000001047.
Evaluate the effect of US geographic region on outcomes of helicopter transport (HT) for trauma.
HT is an integral component of trauma systems. Evidence suggests that HT is associated with improved outcomes; however, no studies examine the impact of geographic variation on outcomes for HT.
Retrospective cohort study of patients undergoing scene HT or ground transport in the National Trauma Databank (2009-2012). Subjects were divided by US census region. HT and ground transport subjects were propensity-score matched based on prehospital physiology and injury severity. Conditional logistic regression was used to evaluate the effect of HT on survival and discharge to home in each region. Region-level characteristics were assessed as potential explanatory factors.
A total of 193,629 pairs were matched. HT was associated with increased odds of survival and discharge to home; however, the magnitude of these effects varied significantly across regions (P < 0.01). The South had the greatest survival benefit (odds ratio: 1.44; 95% confidence interval: 1.39-1.49, P < 0.01) and the Northeast had the greatest discharge to home benefit (odds ratio: 1.29; 95% confidence interval: 1.18-1.41, P < 0.01). A subset of region-level characteristics influenced the effect of HT on each outcome, including helicopter utilization, injury severity, trauma center and helicopter distribution, trauma center access, traffic congestion, and urbanicity (P < 0.05).
Geographic region impacts the benefits of HT in trauma. Variations in resource allocation partially account for outcome differences. Policy makers should consider regional factors to better assess and allocate resources within trauma systems to optimize the role of HT.
评估美国地理区域对创伤直升机转运（HT）结局的影响。
HT是创伤系统的一个重要组成部分。有证据表明HT与改善结局相关；然而，尚无研究考察地理差异对HT结局的影响。
对国家创伤数据库（2009 - 2012年）中接受现场HT或地面转运的患者进行回顾性队列研究。受试者按美国人口普查区域划分。基于院前生理状况和损伤严重程度，对HT和地面转运受试者进行倾向得分匹配。采用条件逻辑回归评估HT对各区域生存及出院回家的影响。将区域层面的特征作为潜在解释因素进行评估。
共匹配了193,629对。HT与生存及出院回家的几率增加相关；然而，这些影响在各区域间差异显著（P<0.01）。南部生存获益最大（优势比：1.44；95%置信区间：1.39 - 1.49，P<0.01），东北部出院回家获益最大（优势比：1.29；95%置信区间：1.18 - 1.41，P<0.01）。区域层面特征的一个子集影响了HT对各结局的作用，包括直升机利用率、损伤严重程度、创伤中心及直升机分布、创伤中心可达性、交通拥堵和城市化程度（P<0.05）。
地理区域影响创伤中HT的获益。资源分配的差异部分解释了结局差异。政策制定者应考虑区域因素，以便更好地评估和分配创伤系统内的资源，从而优化HT的作用。
