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Citation
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Sun H, Samra NS, Kalakoti P, Sharma K, Patra DP, Dossani RH, Thakur JD, Disbrow EA, Phan K, Veeranki SP, Pabaney A, Notarianni C, Owings JT, Nanda A. World Neurosurg. 2017; 104: 909-918.e8. |
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Abstract
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INTRODUCTION: Prehospital helicopter utilization and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS) using data derived from the National Trauma Data Bank (2007-2014).
METHODS: Primary and secondary endpoints were defined as in-hospital survival, and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were employed to investigate the association of helicopter transport with survival as compared to ground EMS.
RESULTS: Of the 1018 snowboarders and skiers that met the criteria, 360 (35.6%) were transported via helicopters while 658 (64.8%) via ground EMS with a mortality rate of 1.7% and 1.5% respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (OR: 8.58; 95%CI: 1.09-67.64; p=0.041; ARR: 10.06%). This finding persisted following propensity score matching (OR: 24.73; 95%CI: 5.74-152.55; p<0.001). The corresponding ARR implies that approximately 10 patients need to be transported via helicopter to save 1 life.
CONCLUSIONS: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport has improved survival in patients incurring TBI following snowboard or ski related falls compared to those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.
Copyright © 2017. Published by Elsevier Inc.
Language: en |