Elswick Clay M, Wyrick Deidre, Gurien Lori A, Rettiganti Malik, Gowen Marie, Pownall Ambre', Bahgat Diaa, Maxson R Todd, Öcal Eylem, Albert Gregory W
Department of Neurosurgery, Wayne State University, Detroit, MI.
Division of Surgery, Arkansas Children's Hospital and Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
J Pediatr Surg. 2018 Sep;53(9):1795-1799. doi: 10.1016/j.jpedsurg.2018.04.032. Epub 2018 May 1.
Helicopter emergency medical services (HEMS) have provided benefit for severely injured patients. However, HEMS are likely overused for the transportation of both adult and pediatric trauma patients. In this study, we aim to evaluate the degree of overuse of helicopter as a mode of transport for head-injured children. In addition, we propose criteria that can be used to determine if a particular patient is suitable for air versus ground transport.
We identified patients who were transported to our facility for head injuries. We included only those patients who were transported from another facility and who were seen by the neurosurgical service. We recorded a number of data points including age, gender, race, Glasgow Coma Score (GCS), and intubation status. We also collected data on a number of imaging findings such as mass effect, edema, intracranial hemorrhage, and skull fractures. Patients undergoing emergent nonneurosurgical intervention were excluded.
Of the 373 patients meeting inclusion criteria, 116 (31.1%) underwent a neurosurgical procedure or died and were deemed appropriate for helicopter transport. The remaining 68.9% of patients survived their injuries without neurosurgical intervention and were deemed nonappropriate for helicopter transport. Multivariable logistic regression identified GCS 3-8 and/or presence of mass effect, edema, epidural hematoma (EDH), and open-depressed skull fracture as appropriate indications for helicopter transport.
The majority of patients transported to our facility by helicopter survived their head injury without need for neurosurgical intervention. Only those patients meeting clinical (GCS 3-8) or radiographic (mass effect, edema, EDH, open-depressed skull fracture) criteria should be transported by air.
Level III (Diagnostic Study).
直升机紧急医疗服务（HEMS）已为重伤患者带来益处。然而，HEMS在成人和儿童创伤患者的转运中可能存在过度使用的情况。在本研究中，我们旨在评估直升机作为头部受伤儿童运输方式的过度使用程度。此外，我们提出了可用于确定特定患者适合空中还是地面运输的标准。
我们确定了被转运至我院治疗头部损伤的患者。我们仅纳入那些从其他机构转运而来且由神经外科服务诊治的患者。我们记录了一些数据点，包括年龄、性别、种族、格拉斯哥昏迷评分（GCS）和插管状态。我们还收集了一些影像学检查结果的数据，如占位效应、水肿、颅内出血和颅骨骨折。接受紧急非神经外科干预的患者被排除。
在373名符合纳入标准的患者中，116名（31.1%）接受了神经外科手术或死亡，被认为适合直升机转运。其余68.9%的患者受伤后存活且无需神经外科干预，被认为不适合直升机转运。多变量逻辑回归确定GCS 3 - 8分和/或存在占位效应、水肿、硬膜外血肿（EDH）及开放性凹陷性颅骨骨折是直升机转运的合适指征。
大多数通过直升机转运至我院的患者头部受伤后存活，无需神经外科干预。只有那些符合临床（GCS 3 - 8分）或影像学（占位效应、水肿、EDH、开放性凹陷性颅骨骨折）标准的患者才应通过空中转运。
III级（诊断性研究）。
