Andruszkow Hagen, Schweigkofler Uwe, Lefering Rolf, Frey Magnus, Horst Klemens, Pfeifer Roman, Beckers Stefan Kurt, Pape Hans-Christoph, Hildebrand Frank
Department of Orthopedic Trauma at Aachen University and Harald Tscherne Laboratory, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389 Frankfurt am Main, Germany.
PLoS One. 2016 Jan 15;11(1):e0146897. doi: 10.1371/journal.pone.0146897. eCollection 2016.
The Helicopter Emergency Medical Service (HEMS) was established for the prehospital trauma care of patients. Improved rescue times and increased coverage areas are discussed as specific advantages of HEMS. We recently found evidence that HEMS exerts beneficial effects on outcomes for severely injured patients. However, it still remains unknown which group of trauma patients might benefit most from HEMS rescue. Consequently, the unique aim of this study was to reveal which patients might benefit most from HEMS rescue.
Trauma patients (ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2002 and 2012 were analysed using the TraumaRegister DGU. A multivariate regression analysis was used to reveal the survival benefit between different trauma populations.
The study included 52 281 trauma patients. Of these, 68.8% (35 974) were rescued by GEMS and 31.2% (16 307) by HEMS. HEMS patients were more severely injured compared to GEMS patients (ISS: HEMS 24.8±13.5 vs. GEMS 21.7±18.0) and more frequently suffered traumatic shock (SBP sys <90mmHg: HEMS 18.3% vs. GEMS 14.8%). However, logistic regression analysis revealed that HEMS rescues resulted in an overall survival benefit compared to GEMS (OR 0.81, 95% CI [0.75-0.87], p<0.001, Nagelkerke's R squared 0.526, area under the ROC curve 0.922, 95% CI [0.919-0.925]). Analysis of specific subgroups demonstrated that patients aged older than 55 years (OR 0.62, 95% CI [0.50-0.77]) had the highest survival benefit after HEMS treatment. Furthermore, HEMS rescue had the most significant impact after 'low falls' (OR 0.68, 95% CI [0.55-0.84]) and in the case of minor severity injuries (ISS 9-15) (OR 0.66, 95% CI [0.49-0.88]).
In general, trauma patients benefit from HEMS rescue with in-hospital survival as the main outcome parameter. Focusing on special subgroups, middle aged and older patients, low-energy trauma, and minor severity injuries had the highest survival benefit when rescued by HEMS. Further studies are required to determine the potential reasons of this benefit.
直升机紧急医疗服务（HEMS）是为院前创伤患者的救治而设立的。缩短救援时间和扩大覆盖区域被认为是HEMS的具体优势。我们最近发现有证据表明，HEMS对重伤患者的预后有有益影响。然而，仍不清楚哪类创伤患者可能从HEMS救援中获益最大。因此，本研究的唯一目的是揭示哪些患者可能从HEMS救援中获益最大。
使用创伤登记数据库DGU分析了2002年至2012年间主要由HEMS或地面紧急医疗服务（GEMS）治疗的创伤患者（损伤严重度评分[ISS]≥9）。采用多因素回归分析来揭示不同创伤人群之间的生存获益情况。
该研究纳入了52281例创伤患者。其中，68.8%（35974例）由GEMS救援，31.2%（16307例）由HEMS救援。与GEMS患者相比，HEMS患者的损伤更严重（ISS：HEMS为24.8±13.5，GEMS为21.7±18.0），且更常发生创伤性休克（收缩压<90mmHg：HEMS为18.3%，GEMS为14.8%）。然而，逻辑回归分析显示，与GEMS相比，HEMS救援能带来总体生存获益（比值比[OR]为0.81，95%置信区间[CI][0.75 - 0.87]，p<0.001，Nagelkerke's R平方为0.526，ROC曲线下面积为0.922，95%CI[0.919 - 0.925]）。对特定亚组的分析表明，年龄大于55岁的患者（OR为0.62，95%CI[0.5 - 0.77]）在接受HEMS治疗后生存获益最高。此外，在“低跌落伤”（OR为0.68，95%CI[0.55 - 0.84]）以及轻伤（ISS为9 - 15）的情况下，HEMS救援的影响最为显著（OR为
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