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Citation
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Englum BR, Rialon KL, Kim J, Shapiro ML, Scarborough JE, Rice HE, Adibe OO, Tracy ET. J. Pediatr. Surg. 2016; 52(1): 140-144. |
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Affiliation
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Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States. |
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Abstract
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PURPOSE: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries.
METHODS: All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included.
RESULTS: Of 127,489 included patients, 18,291 (14%) arrived via HEMS, compared to 56% by ground ambulance and 29% by private vehicle/walk-in. HEMS patients had more severe injuries (ISS≥25; 28% vs. 14%) and altered mental status (GCS≤8; 29% vs. 11%), but also contained many patients with only minor injuries or no major physiologic derangements. In unadjusted analysis, HEMS was associated with increased mortality (OR: 1.6; 95% CI: 1.4-1.7). However, it had decreased mortality by regression (0.5; 0.4-0.6) and propensity analysis (0.7; 0.6-0.8) to adjust for confounders.
CONCLUSION: We found multiple indicators for overuse of HEMS, with nearly 40% of children having only minor injuries. In moderate/severe injuries, HEMS is associated with decreased mortality, potentially saving one life for every 47 flights. Research is needed to determine appropriate criteria for helicopter triage. COMPARATIVE STUDY/LEVEL OF EVIDENCE: III.
Copyright © 2016. Published by Elsevier Inc.
Language: en |