Keck School of Medicine of USC, Los Angeles.
University of Arizona, Tucson.
J Burn Care Res. 2020 Jan 30;41(1):15-22. doi: 10.1093/jbcr/irz143.
Eighty-eight percent of all patients burned in North America suffer burns of less than 20% TBSA. These patients may need care at a burn center, but barring any inhalation injury or polytrauma, these patients do not require helicopter transport (HEMS). We sought to identify a cohort of patients suffering smaller burns who do not benefit from HEMS to establish significant health care system savings. A 5-year retrospective analysis of data collected from our trauma registry was performed. Patients were separated into two groups: HEMS and ground transport (EMS). A subanalysis was performed between those with smaller burns (<20% TBSA and no ICU/OR requirement). ED disposition, hospital length of stay, distance transported, and cost was analyzed. Of 616 burn patients presenting to our center, 13% were transported by HEMS, 46% by ambulance, and 61% by private vehicle. Of those transported via HEMS, 38% had been evaluated and treated at an outside hospital before transfer. Patients transported via HEMS had larger burns (13 vs 9 %TBSA; P = .002) and deeper burns (P < .001), longer hospital stays (P = .003), higher ICU admission rates (P < .001), and mortality rates (P = .003) compared with those transported by EMS. Transport distance was a mean 5.5 times greater (88 vs 16 mi) in the HEMS group (P < .001). Within this cohort, 53% of patients transported via HEMS suffered smaller burns, compared with 73% transported by EMS. A subanalysis of the smaller burns cohort showed increased distances of transport via HEMS (91 vs 18 mi; P < .001) and increased rates of admission from the ED in the EMS group (93% vs 68% by HEMS; P = .005), yet no difference in length of stay, or rates of early discharge, defined as <24-hour hospital stay. Fully 1/4 of those transported via HEMS with smaller burns were discharged from the ED after burn consultation, debridement, and dressing. Mortality in both was nil. Average cost per helicopter transport was US$29K. Accurate triage and burn center consultation before scene transport or hospital transfer could help identify patients not benefiting from HEMS yet safely transferrable by ground, or better served by early clinic follow-up, which would reduce cost without compromising care in this cohort. Annual patient savings approximating US$444K could be multiplied were non-HEMS transport universally adopted for smaller burns.
北美 88%的烧伤患者的烧伤面积均小于 20%TBSA。这些患者可能需要在烧伤中心接受治疗，但如果没有吸入性损伤或多发伤，这些患者不需要直升机转运（HEMS）。我们试图确定一组没有受益于 HEMS 的较小烧伤患者的队列，以建立显著的医疗保健系统节省。对从我们的创伤登记处收集的数据进行了为期 5 年的回顾性分析。患者分为两组：HEMS 和地面运输（EMS）。在烧伤面积小于 20%TBSA 且不需要 ICU/OR 的患者中进行了亚分析。分析了急诊部处置、住院时间、运输距离和费用。在我院就诊的 616 例烧伤患者中，13%通过 HEMS 转运，46%通过救护车转运，61%通过私家车转运。通过 HEMS 转运的患者中，38%在转院前曾在外部医院接受评估和治疗。通过 HEMS 转运的患者烧伤面积更大（13%比 9%TBSA；P=.002），烧伤程度更深（P<.001），住院时间更长（P=.003），ICU 入院率更高（P<.001），死亡率更高（P=.003），与通过 EMS 转运的患者相比。HEMS 组的平均转运距离大 5.5 倍（88 比 16 英里）（P<.001）。在该队列中，通过 HEMS 转运的患者中有 53%的烧伤面积较小，而通过 EMS 转运的患者中有 73%的烧伤面积较小。对较小烧伤患者队列的亚分析显示，通过 HEMS 转运的距离增加（91 比 18 英里；P<.001），EMS 组在急诊科的入院率增加（93%比 HEMS 组的 68%；P=.005），但住院时间或早期出院率（定义为住院时间<24 小时）没有差异。完全有 1/4 的通过 HEMS 转运的较小烧伤患者在烧伤咨询、清创和包扎后从急诊部出院。两组均无死亡病例。每架直升机转运的平均费用为 29000 美元。在现场转运或医院转院前进行准确的分诊和烧伤中心咨询，可以帮助确定那些没有受益于 HEMS 但可以通过地面安全转运的患者，或者通过早期门诊随访更好地治疗，这将在不影响该队列护理的情况下降低成本。如果普遍采用非 HEMS 转运较小的烧伤，每年可节省约 44.4 万美元的患者费用。
