title: Helicopters improve survival in seriously injured patients requiring interfacility transfer for definitive care.
abstract: BACKGROUND
  Helicopter transport (HT) is frequently used for interfacility transfer of injured patients to a trauma center. The benefits of HT over ground transport (GT) in this setting are unclear. By using a national sample, the objective of this study was to assess whether HT impacted outcomes following interfacility transfer of trauma patients.
  
  
  METHODS
  Patients transferred by HT or GT in 2007 were identified using the National Trauma Databank (version 8). Injury severity, resource utilization, and survival to discharge were compared. Stepwise logistic regression was used to determine whether transport modality was a predictor of survival after adjusting for covariates. Regression analysis was repeated in subgroups with Injury Severity Score (ISS)≤15 and ISS>15.
  
  
  RESULTS
  There were 74,779 patients transported by helicopter (20%) or ground (80%). Mean ISS was higher in patients transported by helicopter (17±11 vs. 12±9; p<0.01) as was the proportion with ISS>15 (49% vs. 28%; odds ratio [OR], 2.53; 95% confidence interval [CI], 2.43-2.63). Patients transported by helicopter had higher rates of intensive care unit admission (54% vs. 29%; OR, 2.86; 95% CI, 2.75-2.96), had shorter transport time (61±55 minutes vs. 98±71 minutes; p<0.01), and had shorter overall prehospital time (135±86 minutes vs. 202±132 minutes; p<0.01). HT was not a predictor of survival overall or in patients with ISS≤15. In patients with ISS>15, HT was a predictor of survival (OR, 1.09; 95% CI, 1.02-1.17; p=0.01).
  
  
  CONCLUSIONS
  Patients transported by helicopter were more severely injured and required more hospital resources than patients transported by ground. HT offered shorter transport and overall prehospital times. For patients with ISS>15, HT was a predictor of survival. These findings should be considered when developing interfacility transfer policies for patients with severe injuries.
authors.affiliation: +Strong Regional Trauma Center, Department of Surgery, University of Rochester School of Medicine, Rochester, New York 14642-8410, USA.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Brown
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Stassen
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bankey
authors.forename: Ayodele T
authors.initials: AT
authors.lastname: Sangosanya
authors.forename: Julius D
authors.initials: JD
authors.lastname: Cheng
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gestring
mesh_terms: D017732:Air Ambulances / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010360:Patient Transfer / Q000379:methods / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*