title: Interhospital helicopter transport for stroke.
abstract: BACKGROUND
  The safety, cost efficacy, and time-to-treatment benefit of air transport of stroke patients have been acknowledged. We describe stroke patients transported to our facility by helicopter emergency medical services (HEMS) from a large rural area and compare 2 consecutive 3-year periods.
  
  
  METHODS
  A retrospective chart review was conducted of all patients transferred by HEMS to our facility over 6 years. Data collected included patient demographics, pretransport imaging interpretation, final diagnosis, treatment, and outcomes. Trends between period 1 (January 1, 2003'December 31, 2005) and period 2 (January 1, 2006'December 31, 2008) were examined.
  
  
  RESULTS
  A total of 347 acute stroke patients were transported by HEMS to our facility. The final diagnosis was intracerebral hemorrhage in 44%, subarachnoid hemorrhage in 24%, subdural hematoma in 14%, ischemic stroke or transient ischemic attack in 9%, and a nonstroke diagnosis in 7% of patients. Conventional cerebral angiography was performed in 28% of patients, and neurosurgical intervention, hematoma evacuation, or aneurysm clipping was performed in 32%. A final diagnosis of ischemic stroke or transient ischemic attack increased 3 times (4% vs. 12%, P < .05) from period 1 to 2. There was also a significant increase in the number of patients receiving intravenous tissue plasminogen activator before transport (0% vs. 3%, P < .01).
  
  
  CONCLUSIONS
  The majority of our patients transported by HEMS for the management of acute stroke undergo urgent specialized diagnostics or interventions. This supports the role of interhospital HEMS transport in extending access to care in rural communities.
authors.affiliation: The Geisel School of Medicine at Dartmouth, Hanover, NH, USA. Timothy.G.Lukovits@Hitchcock.org
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Lukovits
authors.forename: Susannah L
authors.initials: SL
authors.lastname: Von Iderstine
authors.forename: Reed
authors.initials: R
authors.lastname: Brozen
authors.forename: Mark
authors.initials: M
authors.lastname: Pippy
authors.forename: Richard P
authors.initials: RP
authors.lastname: Goddeau
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McDermott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008875:Middle Aged; D010360:Patient Transfer; D012189:Retrospective Studies; D019035:Rural Health Services; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator