Mpody Christian, Rudolph Maíra I, Bastien Alexandra, Karaye Ibraheem M, Straker Tracey, Borngaesser Felix, Eikermann Matthias, Nafiu Olubukola O
Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
Department of Anesthesiology, The Ohio State University, Columbus.
JAMA Surg. 2025 Mar 1;160(3):313-321. doi: 10.1001/jamasurg.2024.6402.
In the US, traumatic injuries are a leading cause of mortality across all age groups. Patients with severe trauma often require time-sensitive, specialized medical care to reduce mortality; air transport is associated with improved survival in many cases. However, it is unknown whether the provision of and access to air transport are influenced by factors extrinsic to medical needs, such as race or ethnicity.
To examine the current trends of racial and ethnic disparities in air transport use for patients who sustain severe trauma.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the National Trauma Data Bank from 2016 to 2022. Participants were patients older than 15 years who sustained a severe injury and required an urgent surgical procedure or intensive care unit (ICU) admission at level I or II trauma centers with helicopter service.
Severe injury requiring treatment at a level I or II trauma center.
The primary mode of transport, categorized as either helicopter ambulance or ground ambulance. A multifaceted approach was used to narrow the observed racial and ethnic disparities in helicopter deployment. The secondary outcome was mortality after helicopter transport vs ground ambulance transport.
Data were included for 341 286 patients at 458 level I or II trauma centers with helicopter service. Their mean (SD) age was 47 (20) years; 243 936 patients (71.6%) were male and 96 633 (28.4%) female. Asian individuals were less likely to receive helicopter transport compared with White individuals (6.8% vs 21.8%; aRR, 0.38; 95% CI, 0.30-0.48; P < .001), driven by lower use for Asian patients in teaching hospitals (aRR, 0.29; 95% CI, 0.21-0.40; P < .001) and level I trauma centers (aRR, 0.33; 95% CI, 0.24-0.44; P < .001). In addition, Black patients were less likely to receive helicopter transport (8.7% vs 21.8%; aRR, 0.42; 95% CI, 0.36-0.49; P < .001), particularly in teaching hospitals (aRR, 0.41; 95% CI, 0.33-0.50; P < .001) and level I trauma centers (aRR, 0.40; 95% CI, 0.34-0.49; P < .001). A similar but less pronounced disparity was noted for Hispanic patients. Helicopter transport was associated with a lower mortality risk compared with ground transport (37.7% vs 42.6%; adjusted relative risk [aRR], 0.87; 95% CI, 0.85-0.89; P < .001).
This study found that racial and ethnic minority patients, particularly Asian and Black patients, and notably those treated at level I teaching hospitals were less likely to receive airlift services compared with White patients. The current expansion of helicopter emergency medical services has yet to translate into equitable care for patients of all races and ethnicities.
在美国，创伤性损伤是所有年龄组死亡的主要原因。严重创伤患者通常需要及时、专业的医疗护理以降低死亡率；在许多情况下，空中转运与提高生存率相关。然而，空中转运的提供和可及性是否受到医疗需求以外的因素影响，如种族或民族，尚不清楚。
研究严重创伤患者空中转运使用中种族和民族差异的当前趋势。
设计、背景和参与者：这项基于人群的队列研究使用了2016年至2022年国家创伤数据库的数据。参与者为15岁以上在具备直升机服务的一级或二级创伤中心遭受严重损伤且需要紧急外科手术或入住重症监护病房（ICU）的患者。
在一级或二级创伤中心需要治疗的严重损伤。
主要转运方式，分为直升机救护车或地面救护车。采用多方面方法来缩小直升机部署中观察到的种族和民族差异。次要结局是直升机转运与地面救护车转运后的死亡率。
纳入了458个具备直升机服务的一级或二级创伤中心的341286例患者的数据。他们的平均（标准差）年龄为47（20）岁；243936例患者（71.6%）为男性，96633例患者（28.4%）为女性。与白人患者相比，亚洲人接受直升机转运的可能性较小（6.8%对21.8%；调整后相对风险[aRR]，0.38；95%置信区间[CI]，0.30 - 0.48；P <.001），这是由于教学医院（aRR，0.29；95% CI，0.21 - 0.40；P <.001）和一级创伤中心（aRR，0.33；95% CI，0.24 - 0.44；P <.001）中亚洲患者的使用率较低。此外，黑人患者接受直升机转运的可能性较小（8.7%对21.8%；aRR，0.42；95% CI，0.36 - 0.49；P <.001），特别是在教学医院（aRR，0.41；95% CI，0.33 - 0.50；P <.001）和一级创伤中心（aRR。40；95% CI，0.34 - 0.49；P <.001）。西班牙裔患者也存在类似但不太明显的差异。与地面转运相比，直升机转运与较低的死亡风险相关（37.7%对42.6%；调整后相对风险[aRR]，0.87；95% CI，0.85 - 0.89；P <.001）。
本研究发现，与白人患者相比，种族和民族少数群体患者，特别是亚洲和黑人患者，尤其是在一级教学医院接受治疗的患者，接受空运服务的可能性较小。当前直升机紧急医疗服务的扩展尚未转化为对所有种族和民族患者的公平护理。
