UT Health Science Center San Antonio, Department of Surgery, San Antonio, TX, USA.
UT Health Science Center San Antonio, Department of Pediatrics, San Antonio, TX, USA.
Pediatr Res. 2024 Jan;95(1):188-192. doi: 10.1038/s41390-023-02761-5. Epub 2023 Aug 3.
Decision making regarding transportation mode after a traumatic injury may have a significant impact on outcomes, due to differences in time to definitive care. The objective of this study was to determine if transport mode had an impact on in-hospital mortality and discharge disposition in pediatric trauma patients.
Data were abstracted from the National Trauma Data Bank from 2007 to 2016 comparing helicopter and ground transportation modes effects on mortality and discharge outcomes. The primary outcome was in-hospital death, while the secondary outcome was discharge home without services (DCHWOS). Analyses included logistic regression modeling and propensity score matching.
Significant variables from univariate analysis were included in the multivariate, propensity-matched regression model. Pediatric trauma patients transported by helicopter had lower odds of mortality (OR 0.69 [0.64,0.75]) and higher odds of DCHWOS (1.29 [1.20,1.39]). There were no differences in overall mechanism, but individual injury patterns showed higher odds of mortality.
Critical decisions regarding triage of patients by different modes of transport occur every day. This study supports the current literature on the topic and shows a potential additional benefit of a meaningful discharge outcome for those transported by helicopter.
This study may impact prehospital triage decision making process for pediatric trauma patients on mortality. Prehospital transport mode may contribute to pediatric trauma discharge outcomes. Highlights the need for future research regarding non-clinical data that is unable to be abstracted from national databases (e.g., family dynamics, insurance status, weather, access to post-discharge resources).
创伤后交通方式的决策可能会对结果产生重大影响，因为到达确定性治疗的时间存在差异。本研究的目的是确定运输方式是否会对儿科创伤患者的院内死亡率和出院去向产生影响。
从 2007 年至 2016 年，从国家创伤数据库中提取数据，比较直升机和地面运输方式对死亡率和出院结果的影响。主要结局是院内死亡，次要结局是无服务（DCHWOS）出院回家。分析包括逻辑回归模型和倾向评分匹配。
单变量分析中的显著变量被纳入多变量、倾向评分匹配的回归模型。通过直升机转运的儿科创伤患者死亡的可能性较低（OR 0.69 [0.64,0.75]），DCHWOS 的可能性较高（1.29 [1.20,1.39]）。总体机制没有差异，但个别损伤模式显示出更高的死亡率。
每天都会对不同运输方式的患者进行分诊的关键决策。本研究支持该主题的现有文献，并表明对通过直升机转运的患者来说，有一个有意义的出院结果的潜在额外益处。
这项研究可能会影响儿科创伤患者死亡率的院前分诊决策过程。院前运输方式可能会影响儿科创伤患者的出院结果。强调需要对无法从国家数据库中提取的非临床数据（例如家庭动态、保险状况、天气、出院后资源的获取）进行未来研究。
