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Resource utilization and indications for helicopter transport of head-injured children.

Abstract：

INTRODUCTION:Helicopter emergency medical services (HEMS) have provided benefit for severely injured patients. However, HEMS are likely overused for the transportation of both adult and pediatric trauma patients. In this study, we aim to evaluate the degree of overuse of helicopter as a mode of transport for head-injured children. In addition, we propose criteria that can be used to determine if a particular patient is suitable for air versus ground transport. MATERIALS AND METHODS:We identified patients who were transported to our facility for head injuries. We included only those patients who were transported from another facility and who were seen by the neurosurgical service. We recorded a number of data points including age, gender, race, Glasgow Coma Score (GCS), and intubation status. We also collected data on a number of imaging findings such as mass effect, edema, intracranial hemorrhage, and skull fractures. Patients undergoing emergent nonneurosurgical intervention were excluded. RESULTS:Of the 373 patients meeting inclusion criteria, 116 (31.1%) underwent a neurosurgical procedure or died and were deemed appropriate for helicopter transport. The remaining 68.9% of patients survived their injuries without neurosurgical intervention and were deemed nonappropriate for helicopter transport. Multivariable logistic regression identified GCS 3-8 and/or presence of mass effect, edema, epidural hematoma (EDH), and open-depressed skull fracture as appropriate indications for helicopter transport. CONCLUSIONS:The majority of patients transported to our facility by helicopter survived their head injury without need for neurosurgical intervention. Only those patients meeting clinical (GCS 3-8) or radiographic (mass effect, edema, EDH, open-depressed skull fracture) criteria should be transported by air. LEVEL OF EVIDENCE:Level III (Diagnostic Study).

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Elswick CM,Wyrick D,Gurien LA,Rettiganti M,Gowen M,Pownall A,Bahgat D,Maxson RT,Öcal E,Albert GW

doi

10.1016/j.jpedsurg.2018.04.032

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

1795-1799

issue

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(18)30306-3

journal_volume

pub_type

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Resource utilization and indications for helicopter transport of head-injured children.