Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services
Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services
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DOI：
10.3109/10903127.2011.569849
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发表时间：
2011-07-01
影响因子：
2.4
通讯作者：
Wald, Marlena M.
中科院分区：
文献类型：
--
作者：
Sullivent, Ernest E.;Faul, Mark;Wald, Marlena M.
背景资料。一些研究表明，直升机紧急医疗服务(HEMS)运输的结果有所改善，而另一些研究则没有。安全问题和成本促使人们重新评估HEMS的广泛使用。目标。确定创伤患者的运输方式是否会影响死亡率。方法：研究方法。通过直升机或地面救护车运送到美国62个创伤中心的56,744名受伤成年人的数据来自2007年国家创伤数据库的国家样本计划。计算不同人口统计学和损伤严重程度组的住院死亡率。调整后的优势比(AOR)是通过利用Logistic回归模型测量死亡率和运输类型的关联，控制年龄、性别和损伤严重程度(损伤严重程度评分[ISS]和修订的创伤评分[[RTS]])来产生的。结果。HEMS运送的死亡率比地面救护车运送的死亡率低39%(AOR==0.61，95%可信区间[CI]==0.54~-0.69)。55岁年龄组的死亡率差异无统计学意义(AOR=0.92，95%CI=0.74~-1.13)。在所有运输方式中，男性患者的死亡几率(AOR==1.23，95%CI==1.10~1.38)高于女性患者。死亡风险随年龄(AOR=1.040，95%CI==1.037~1.043)和ISS各单位(AOR=1.080，95%CI=1.075~1.084)的增加而增加，随RTS的增加而降低(AOR=0.46，95%CI==0.45~1.084)。结论。使用HEMS运送成年创伤患者与降低18-54岁患者的死亡率有关。在这项研究中，HEMS并没有改善55岁的成年人的死亡率。在选择那些将从HEMS运输中受益的患者时，确定其他变量有望加强死亡率的降低。
Background. Some studies have shown improved outcomes with helicopter emergency medical services (HEMS) transport, while others have not. Safety concerns and cost have prompted reevaluation of the widespread use of HEMS. Objective. To determine whether the mode of transport of trauma patients affects mortality. Methods. Data for 56,744 injured adults aged >= a parts per thousand yen18 years transported to 62 U.S. trauma centers by helicopter or ground ambulance were obtained from the National Sample Program of the 2007 National Trauma Data Bank. In-hospital mortality was calculated for different demographic and injury severity groups. Adjusted odds ratios (AOR) were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [[ISS]] and Revised Trauma Score [[RTS]]). Results. The odds of death were 39%% lower in those transported by HEMS compared with those transported by ground ambulance (AOR == 0.61, 95%% confidence interval [[CI]] == 0.54--0.69). Among those aged >= a parts per thousand yen55 years, the odds of death were not significantly different (AOR == 0.92, 95%% CI == 0.74--1.13). Among all transports, male patients had a higher odds of death (AOR == 1.23, 95%% CI == 1.10--1.38) than female patients. The odds of death increased with each year of age (AOR == 1.040, 95%% CI == 1.037--1.043) and each unit of ISS (AOR == 1.080, 95%% CI == 1.075--1.084), and decreased with each unit of RTS (AOR == 0.46, 95%% CI == 0.45--0.48). Conclusion. The use of HEMS for the transport of adult trauma patients was associated with reduced mortality for patients aged 18--54 years. In this study, HEMS did not improve mortality in adults aged >= a parts per thousand yen55 years. Identification of additional variables in the selection of those patients who will benefit from HEMS transport is expected to enhance this reduction in mortality.