Sun Hai, Samra Navdeep S, Kalakoti Piyush, Sharma Kanika, Patra Devi Prasad, Dossani Rimal H, Thakur Jai Deep, Disbrow Elizabeth A, Phan Kevin, Veeranki Sreenivas P, Pabaney Aqueel, Notarianni Christina, Owings John T, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
Department of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
World Neurosurg. 2017 Aug;104:909-918.e8. doi: 10.1016/j.wneu.2017.05.108. Epub 2017 May 27.
Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014).
Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS.
Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life.
Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.
对于滑雪板爱好者和滑雪者发生创伤性脑损伤（TBI）后，院前直升机的使用情况及其对预后的影响尚不清楚。本研究利用国家创伤数据库（2007 - 2014年）的数据，调查直升机转运与滑雪板爱好者和滑雪者TBI患者生存情况的关联，并与地面紧急医疗服务（EMS）进行比较。
主要终点和次要终点分别定义为住院生存率和基于转运（治疗）所需数量的绝对风险降低率。使用多变量回归模型，包括传统逻辑模型、拟合广义估计方程的模型以及纳入倾向得分匹配方法结果的模型，来研究直升机转运与地面EMS相比对生存情况的关联。
在符合标准的1018名滑雪板爱好者和滑雪者中，360人（35.4%）通过直升机转运，而658人（64.6%）通过地面EMS转运，死亡率分别为1.7%和1.5%。多变量对数二项式模型显示院前直升机转运与生存率提高有关（优势比8.58；95%置信区间1.09 - 67.64；P = 0.041；绝对风险降低：10.06%）。倾向得分匹配后这一发现仍然存在（优势比24.73；95%置信区间5.74 - 152.55；P < 0.001）。相应的绝对风险降低意味着大约需要10名患者通过直升机转运才能挽救1条生命。
基于我们对回顾性数据的稳健统计分析，我们的研究结果表明，与通过地面EMS转运的患者相比，院前直升机转运可提高滑雪板或滑雪相关摔倒后发生TBI患者的生存率。应实施针对在偏远冬季度假胜地或滑雪或滑雪板场地使用直升机服务的政策。
