Aiolfi Alberto, Benjamin Elizabeth, Recinos Gustavo, De Leon Castro Alejandro, Inaba Kenji, Demetriades Demetrios
Division of Trauma and Surgical Critical Care, University of Southern California, LAC+USC Medical Center, Los Angeles, California.
J Emerg Med. 2018 Mar;54(3):328-334. doi: 10.1016/j.jemermed.2017.11.019. Epub 2017 Dec 16.
The effect of prehospital helicopter emergency medical services (HEMS) on mortality has been analyzed previously in polytrauma patients with discordant results.
Our aim was to compare outcomes in patients with isolated severe blunt traumatic brain injuries (TBIs) transported by HEMS or ground emergency medical services (GEMS).
We conducted a National Trauma Data Bank study (2007-2014). All adult patients (≥16 years old) who sustained an isolated severe blunt TBI and were transported by HEMS or GEMS were included in the study.
There were 145,559 patients who met the inclusion criteria. Overall, 116,391 (80%) patients were transported via GEMS and 29,168 (20%) via HEMS. Median transportation time was longer for HEMS patients (41 vs. 25 min; p < 0.001). HEMS patients were more likely to have hypotension (2.7% vs. 1.5%; p < 0.001), Glasgow Coma Scale (GCS) score < 9 (38.2% vs. 10.9%; p < 0.001), and head Abbreviation Injury Scale (AIS) score of 5 (20.1% vs. 9.7%; p < 0.001). Stepwise logistic regression analysis identified age ≥ 65 years old, male sex, hypotension, GCS score < 9, prehospital intubation, and head AIS scores 4 and 5 as independent predictors of mortality. Helicopter transportation was independently associated with improved survival (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.47-0.67; p < 0.001). Admission to a Level I trauma center was an independent predictor of survival (OR 0.64; 95% CI 0.53-0.82; p = 0.001). Regardless of head AIS, helicopter transport was an independent predictor of survival (AIS 3: OR 0.35; p < 0.001; AIS 4: OR 0.44; p < 0.001; AIS 5: OR 0.76; p < 0.001). A prolonged transport time was not an independent predictor of mortality.
Helicopter transport, in adult patients with isolated severe TBI, is associated with improved survival.
此前已对院前直升机紧急医疗服务（HEMS）对多发伤患者死亡率的影响进行了分析，但结果不一致。
我们的目的是比较由HEMS或地面紧急医疗服务（GEMS）转运的孤立性严重钝性创伤性脑损伤（TBI）患者的预后。
我们进行了一项国家创伤数据库研究（2007 - 2014年）。所有成年患者（≥16岁），发生孤立性严重钝性TBI并由HEMS或GEMS转运，均纳入本研究。
有145,559例患者符合纳入标准。总体而言，116,391例（80%）患者通过GEMS转运，29,168例（20%）通过HEMS转运。HEMS患者的中位转运时间更长（41分钟对25分钟；p < 0.001）。HEMS患者更可能出现低血压（2.7%对1.5%；p < 0.001）、格拉斯哥昏迷量表（GCS）评分<9（38.2%对10.9%；p < 0.001）以及头部简明损伤量表（AIS）评分为5（20.1%对9.7%；p < 0.001）。逐步逻辑回归分析确定年龄≥65岁、男性、低血压、GCS评分<9、院前插管以及头部AIS评分为4和5是死亡率的独立预测因素。直升机转运与生存率提高独立相关（优势比[OR]0.55；95%置信区间[CI]0.47 - 0.67；p < 0.001）。入住一级创伤中心是生存的独立预测因素（OR 0.64；95% CI 0.53 - 0.82；p = 0.001）。无论头部AIS如何，直升机转运都是生存的独立预测因素（AIS 3：OR 0.35；p < 0.001；AIS 4：OR 0.44；p < 0.001；AIS 5：OR 0.76；p < 0.001）。转运时间延长不是死亡率的独立预测因素。
在患有孤立性严重TBI的成年患者中，直升机转运与生存率提高相关。
