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Abstract
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INTRODUCTION: Helicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.
METHODS: This multicenter prospective observational study involved 24,293 patients older than 15 years, with an injury severity score (ISS) higher than 15, who had sustained blunt or penetrating trauma, and whose data were recorded from 2004 to 2011 in the Japan Trauma Data Bank (JTDB), which includes data from 114 major emergency hospitals in Japan. The primary outcome was survival to discharge from hospitals. The intervention was either transport by helicopter with physician or ground emergency services.
RESULTS: A total of 2,090 patients were transported by helicopter and 22,203 patients were transported by ground. Overall, 546 patients (26.1%) transported by helicopter died compared with 5765 patients (26.0%) transported by ground services. Patients transported by helicopter had higher ISS than those transported by ground. In multivariable logistic regression, helicopter transport had an odds ratio (OR) for survival to discharge of 1.277 (95% confidence interval (CI), 1.049 to 1.556) after adjusting for age, gender, mechanism of injury, type of trauma, initial vital signs (including systolic blood pressure, heart rate, and respiratory rate), injury severity score (ISS), and pre-hospital treatment (including intubation, airway protection maneuver, and intravenous fluid). In the propensity score-matched cohort, helicopter transport was associated with improved odds of survival compared to ground transport (OR, 1.446; 95% CI, 1.220 to 1.714). In conditional logistic regression after adjusting for pre-hospital treatment (including intubation, airway protection maneuver, intravenous fluid), similar positive associations were observed (OR, 1.230; 95% CI, 1.017 to 1.488).
CONCLUSIONS: Among patients with major trauma in Japan, transport by helicopter with a physician may be associated with improved survival to hospital discharge compared with ground services, after controlling for multiple known confounders.
Language: en |