[The influence of transportation mode on mortality in polytraumatized patients. An analysis based on the German Trauma Registry].
BACKGROUND
Thirty years after its introduction in Germany, the benefits of the helicopter emergency medical service (HEMS) compared to ground ambulances (GA) still remain unclear. The aim of this study was to evaluate the influence of helicopter transport on rescue time and mortality based on the data of the German Trauma Registry.


METHODS
Data from patients with multiple injuries were documented prospectively between 1993 and 2003 in different trauma centers in Germany, Switzerland, Austria and The Netherlands. From these data, patients with an injury severity score (ISS)<16 were excluded. Patients who were transported to the hospital without a physician were also excluded. The data from included patients were evaluated for time to hospital and influence of transportation service on mortality.


RESULTS
A total of 7,534 patients with multiple injuries were included. Of these, 3,870 patients were transported by HEMS and 3,664 reached the hospital by GA. There were 74.9% male patients in the HEMS group, and 71.3% male patients in the GA group. The mean ISS was higher in the HEMS group (31.4 vs 30.7; P<0.01); patients transported by GA were older (HEMS: 39.2; NEF:41.3; P<0.01). The GA arrived on the scene after 14.33 min, the HEMS after 18.18 min (P<0.01). Time at the scene was longer in the HEMS group (HEMS: 26:26 min; NEF: 22:29 min; P<0.01). Intubation rate in the HEMS group was about 80%, while patients transported by GA were intubated in 60% of cases. The overall mortality was 30.9%. Evaluation of the TRISS prediction of survival showed a benefit for patients transported with HEMS. In a multivariate analysis, intubated patients with ISS<or=60 had a lower mortality rate if transported with HEMS (NEF: 40.1%; HEMS 34.9%; P<0.01).


CONCLUSIONS
Only minor differences in age and ISS were found between the groups. The time between the accident and arrival of the physician was longer in the HEMS group. The HEMS group also remained on the scene for longer, but had a higher rate of intervention. According to our analysis of the German Trauma Registry, patients with multiple injuries benefit from HEMS transportation.
Frink
M
M
Unfallchirurgische Klinik, Medizinische Hochschule , Karl-Neuberg-Strasse 1, 30625, Hannover, Germany. michaelfrink@web.de
Probst
C
C
Hildebrand
F
F
Richter
M
M
Hausmanninger
C
C
Wiese
B
B
Krettek
C
C
Pape
H-C
HC
D000328:Adult; D000552:Ambulances / Q000145:classification / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000401:mortality*; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate