Chattopadhyay Arhana, Sheckter Clifford C, Long Chao, Karanas Yvonne
Division of Plastic and Reconstructive Surgery, Stanford University, California.
Clinical Excellence Research Center, Stanford University, California.
J Burn Care Res. 2018 Jun 13;39(4):598-603. doi: 10.1093/jbcr/irx028.
Air ambulances rapidly transport burn patients to regional centers, expediting treatment. However, limited guidelines on transport introduce the risk for inappropriate triage and overuse. Given the additional costs of air vs ground transport, evaluation of transportation use is prudent. A retrospective review of all burn patients transported by helicopter to a single burn center from May 2013 to January 2016 was performed. Data gathered included patient demographics, transfer origin, burn characteristics, and inpatient hospital stay. The primary outcome was appropriate triage based on literature-derived severity criteria. Secondary outcomes included independent predictors of emergent treatments and the cost of overuse. Sixty-eight patients were examined, of which 66% met air ambulance criteria. Inappropriately triaged patients sustained smaller burns (% TBSA 4.8 vs 25.3, P < .001), had fewer flame burns (48 vs 82%, P = .007), had decreased lengths of stay (mean days 8.2 vs 21.2, P = .002), underwent fewer inpatient surgeries (mean 0.69 vs 2.57, P = .006), received no emergent procedures (0 vs 56%, P < .001), and suffered no deaths (0 vs 9%, P < .001). Independent predictors of emergent procedures included transport for airway concern (odds ratio = 45.29, confidence interval = 2.49-825.21, P = .010) and % TBSA (odds ratio = 1.13, confidence interval = 1.02-1.27, P = .019). If the 23 inappropriately triaged patients had been transported by ground, a cost savings of $106,370 could have been realized using 2016 California Medicare reimbursements (per-patient savings of $4624). While appropriate in most circumstances, the cost of air ambulances should be weighed in light of their utility, as a significant proportion of patients did not benefit from air transport.
空中救护车迅速将烧伤患者转运至地区中心，加快了治疗速度。然而，有限的转运指南带来了分诊不当和过度使用的风险。鉴于空中运输与地面运输相比成本更高，对运输使用情况进行评估是审慎的。对2013年5月至2016年1月期间通过直升机转运至单一烧伤中心的所有烧伤患者进行了回顾性研究。收集的数据包括患者人口统计学信息、转运来源、烧伤特征和住院时间。主要结果是根据文献得出的严重程度标准进行适当分诊。次要结果包括紧急治疗的独立预测因素和过度使用的成本。共检查了68例患者，其中66%符合空中救护车标准。分诊不当的患者烧伤面积较小（总体表面积4.8%对25.3%，P <.001），火焰烧伤较少（48%对82%，P =.007），住院时间缩短（平均天数8.2天对21.2天，P =.002），接受的住院手术较少（平均0.69次对2.57次，P =.006），未接受紧急手术（0对56%，P <.001），且无死亡病例（0对9%，P <.001）。紧急手术的独立预测因素包括因气道问题而转运（比值比 = 45.29，置信区间 = 2.49 - 825.21，P =.010）和总体表面积百分比（比值比 = 1.13，置信区间 = 1.02 - 1.27，P =.019）。如果这23例分诊不当的患者通过地面转运，按照2016年加利福尼亚州医疗保险报销标准，可节省106,370美元（每位患者节省4624美元）。虽然在大多数情况下空中救护车是合适的，但鉴于其效用，应权衡空中救护车的成本，因为相当一部分患者并未从空中运输中受益。
