Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge
1 Université de Franche Comté, CHU Besançon, Hôpital J Minjoz, Urgences/SAMU25, 25030, France
2 Université de Bourgogne, CHU Dijon, Hôpital du Bocage, Département de Médecine d'Urgence, 21000, France
3 Université de Lille II, CHRU Lille, Fédération des Urgences-SAMU59, 59000, France
4 CHU Grenoble, Pôle Anesthésie-Réanimation, 38701, France
5 Université Pierre et Marie Curie-Paris 6; GH Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris Service d'Accueil des Urgences, 75013, France
6 Assistance Publique-Hôpitaux de Paris, Hôpital Necker, SAMU de Paris, 75015, France
7 Université de la Méditerranée, CHU Nord, Centre de traumatologie et Département d'Anesthésie Réanimation, 13915, France
8 INSERM CIE 01, CHU Dijon, Centre d'Investigation Clinique-Epidémiologie Clinique, 21000, France
Critical Care 2012, 16:R170 doi:10.1186/cc11647Published: 28 September 2012
The benefits of transporting severely injured patients by helicopter remain controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.
The French Intensive Care Research for Severe Trauma cohort study enrolled 2,703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data, including the mode of transport, (helicopter (HMICU) versus ground (GMICU), both with medical teams), were recorded. The analysis was restricted to patients admitted directly from the scene to a University hospital trauma center. The main endpoint was mortality until ICU discharge.
Of the 1,958 patients analyzed, 74% were transported by GMICU, 26% by HMICU. Median injury severity score (ISS) was 26 (interquartile range (IQR) 19 to 34) for HMICU patients and 25 (IQR 18 to 34) for GMICU patients. Compared to GMICU, HMICU patients had a higher median time frame before hospital admission and were more intensively treated in the pre-hospital phase. Crude mortality until hospital discharge was the same regardless of pre-hospital mode of transport. After adjustment for initial status, the risk of death was significantly lower (odds ratio (OR): 0.68, 95% confidence interval (CI) 0.47 to 0.98, P = 0.035) for HMICU compared with GMICU. This result did not change after further adjustment for ISS and overall surgical procedures.
This study suggests a beneficial impact of helicopter transport on mortality in severe blunt trauma. Whether this association could be due to better management in the pre-hospital phase needs to be more thoroughly assessed.