It's All About Location, Location, Location: A New Perspective on Trauma Transport

Overview

Journal Ann Surg

Specialty General Surgery

Date 2015 Jun 17

PMID 26079917

Citations 4

Authors

Joshua J Shaw

Charles M Psoinos

Heena P Santry

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the effect of aeromedical transport on trauma mortality when accounting for geographic factors.

Background: The existing literature on the mortality benefit of aeromedical transport on trauma mortality is controversial. Studies examining patient and injury characteristics find higher mortality, whereas studies measuring injury severity find a protective effect. Previous studies have not adjusted for the time and distance that would have been traveled had a helicopter not been used.

Methods: Retrospective analysis of an institutional trauma registry. We compared mortality among adult patients (≥15 years) transported from the scene of injury to our level I trauma center by air or ground (January 1, 2000-December 31, 2010) using univariate comparisons and multivariable logistic regression. Regression models were constructed to incrementally account for patient demographics and injury mechanism, followed by injury severity, and, finally, by network bands for drive time and roadway distance as predicted by geographic information systems.

Results: Of 4522 eligible patients, 1583 (35%) were transported by air. Patients transported by air had higher unadjusted mortality (4.1% vs 1.9%, P < 0.05). In multivariable modeling, including patient demographics and type of injury, helicopter transport predicted higher mortality than ground transport (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.2-4.0). After adding validated injury severity measures to the model, helicopter transport predicted lower mortality (OR 0.7, 95% CI 0.3-0.9). Finally, including geographic covariates found that helicopter transport was not associated with mortality (OR 1.1, 95% CI 0.6-2.3).

Conclusions: Helicopter transport does not impart a survival benefit for trauma patients when geographic considerations are taken into account.

Citing Articles

A Systematic Literature Review of Trauma Systems: An Operations Management Perspective.

Wang Z, Rostami-Tabar B, Haider J, Naim M, Haider J Adv Rehabil Sci Pract. 2025; 14():27536351241310645.

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Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services.

Moller T, Ersboll A, Kjaerulff T, Bihrmann K, Alstrup K, Knudsen L Scand J Trauma Resusc Emerg Med. 2021; 29(1):152.

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Distance matters: Effect of geographic trauma system resource organization on fatal motor vehicle collisions.

Brown J, Rosengart M, Billiar T, Peitzman A, Sperry J J Trauma Acute Care Surg. 2017; 83(1):111-118.

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External validation of the Air Medical Prehospital Triage score for identifying trauma patients likely to benefit from scene helicopter transport.

Brown J, Gestring M, Guyette F, Rosengart M, Stassen N, Forsythe R J Trauma Acute Care Surg. 2016; 82(2):270-279.

PMID: 27906867 PMC: 5250556. DOI: 10.1097/TA.0000000000001326.

Geographic distribution of trauma centers and injury-related mortality in the United States.

Brown J, Rosengart M, Billiar T, Peitzman A, Sperry J J Trauma Acute Care Surg. 2015; 80(1):42-9.

PMID: 26517780 PMC: 4688077. DOI: 10.1097/TA.0000000000000902.

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