title: Interfacility transfer of pediatric trauma patients by helicopter does not predict the need for urgent intervention.
abstract: OBJECTIVE
  Helicopter transport can allow trauma patients to reach definitive treatment rapidly, but its appropriate utilization for interfacility transfer to a pediatric trauma center (PTC) has not been well evaluated. This study evaluated differences in variables associated with transport type and intervention at a PTC between helicopter and ground transport for interfacility trauma transfers.
  
  
  METHODS
  This retrospective study evaluated pediatric (<18 years old) trauma patients transferred to a rural PTC over a 5-year period. Records (n = 423) were evaluated for transport type, injuries, mechanism, interventions (eg, operations, transfusions, intubation), and treatment time points. Multiple logistic regression and Cox regression survival analyses were performed to evaluate associations with type of transport and interventions.
  
  
  RESULTS
  Thirty-five percent of patients received intervention at the PTC, with no significant difference between transport types. Helicopter transport was associated with transport distance, respiratory rate greater than 30 breaths/min, pedestrian struck by auto, subdural hematoma, epidural hematoma, pneumothorax, solid organ injury, and vascular compromise/open fracture. Intervention was associated with epidural hematoma, extremity and pelvic fractures, vascular compromise/open fracture, penetrating neck/trunk injury, and complex laceration. Cox regression at less than 6, less than 4, and less than 2 hours after arrival at the PTC demonstrated similar intervention associations. Helicopter transport also correlated with intervention at these time points.
  
  
  CONCLUSIONS
  Most pediatric trauma patients transferred by helicopter did not require interventions. Epidural hematoma, vascular compromise/open fracture, and penetrating neck/trunk injuries predicted prompt interventions (<2 hours) and may have benefited from helicopter transport. There was a disparity between the perceived need for rapid transport and the need for urgent interventions.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA. bengbrecht@hmc.psu.edu
authors.forename: Brett W
authors.initials: BW
authors.lastname: Engbrecht
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Lubin
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cilley
mesh_terms: D000293:Adolescent; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004630:Emergencies; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010414:Pennsylvania; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012424:Rural Population; D014187:Transportation of Patients; D014193:Trauma Centers / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy