Division of Trauma and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
J Surg Res. 2020 Oct;254:135-141. doi: 10.1016/j.jss.2020.04.020. Epub 2020 May 21.
Significant disparities in access to prompt helicopter transport exist among rural trauma populations. We evaluated the impact of an additional helicopter base on transport time and mortality in a rural adult trauma population.
We performed a retrospective cohort study of adult patients with trauma transported by helicopter from scene to a level one trauma center between 2014 and 2018. A new rural helicopter base added to the trauma center's catchment area in 2016 served as the transition time for an interrupted time series analysis. Patients injured in this base's county and adjoining counties were analyzed. Baseline characteristics were compared with a Student's t-test and Pearson's chi-squared test. Cox and linear regression models evaluated the new base's effect on mortality and transport time, respectively.
A total of 332 patients were analyzed: 120 (36.1%) transported before the addition of the new helicopter base and 212 (63.9%) transported after. Patients transported after the addition of the base had higher injury severity score (13.7 versus 10.1, P < 0.001) and were more likely to receive blood en route (19.3% versus 6.7%, P = 0.005). After the addition of the base, there was a decreased hazard ratio for mortality (hazard ratio 0.26, 95% confidence interval: 0.11-0.65, P = 0.004) with no significant change in transport time (-36.7 min, P = 0.071) for the area.
Local helicopter transport units may confer improved survival for the injured patient. This study demonstrates the important role of helicopter transport within a regional trauma system and the impact that expanded access to rapid air transport can have on mortality.
在农村创伤人群中，获得及时直升机转运的机会存在显著差异。我们评估了在农村成年创伤人群中增加一个直升机基地对转运时间和死亡率的影响。
我们对 2014 年至 2018 年间通过直升机从现场转运至一级创伤中心的成年创伤患者进行了回顾性队列研究。2016 年，一个新的农村直升机基地被添加到创伤中心的服务区域内，作为中断时间序列分析的时间转折点。分析了在该基地所在县及其毗邻县受伤的患者。使用学生 t 检验和皮尔逊卡方检验比较了基线特征。Cox 和线性回归模型分别评估了新基地对死亡率和转运时间的影响。
共分析了 332 名患者：120 名（36.1%）在新增直升机基地前转运，212 名（63.9%）在新增直升机基地后转运。新增基地后转运的患者损伤严重程度评分更高（13.7 比 10.1，P<0.001），更有可能在途中接受输血（19.3%比 6.7%，P=0.005）。新增基地后，死亡率的危险比降低（危险比 0.26，95%置信区间：0.11-0.65，P=0.004），但该区域的转运时间没有显著变化（-36.7 分钟，P=0.071）。
当地直升机转运单位可能为受伤患者带来更好的生存机会。本研究表明，直升机转运在区域创伤系统中发挥着重要作用，增加快速空中转运的机会可对死亡率产生重大影响。
