title: Does scene physiology predict helicopter transport trauma admission?
abstract: BACKGROUND
  Helicopter transport (HT) is necessary in the management of civilian trauma; however, its significant expense underscores the need to minimize overuse and inefficiency. Our objective was to determine whether on-scene physiologic criteria predict appropriate triage in HT trauma patients.
  
  
  METHODS
  We performed a retrospective review of patients flown from the injury scene to the emergency department of a level 1 trauma center by a university HT service from January 2006 to December 2010. Demographics, mechanism of injury, scene revised trauma score (RTS), travel distance, trauma alert level, payer status, emergency department and hospital disposition, and injury severity scores were queried from the electronic medical record and Trauma Registry of the American College of Surgeons with similar data on patients admitted because of trauma by ground transport for comparison. Proper triage criteria were defined through by the American College of Surgeons Committee on Trauma.
  
  
  RESULTS
  We identified 2522 HT patients. Of these, 1491 (59%) were properly triaged and 1031 (41%) were overtriaged. Univariate analysis revealed that the mean scene RTS was significantly higher for over- versus proper triage (7.68 ± 0.67 and 6.97 ± 1.57 respectively, P < 0.001). Neither the scene RTS nor travel distance predicted the triage criteria in a regression model (odds ratio 0.37, 95% confidence interval 0.16-0.85, and odds ratio 0.67, 95% confidence interval 0.60-0.74, respectively). Compared with ground transport, admitted HT patients had significantly more blunt trauma, lower scene RTSs, higher injury severity scores, more intensive care unit and ventilator days, a longer length of stay, and a greater travel distance and were more likely to be intubated (P < 0.001).
  
  
  CONCLUSIONS
  The physiological criteria did not predict the triage status in HT trauma patients. Although >40% of HT patients were overtriaged, they were more severely injured and required greater institutional resources than did the ground transport patients. Overtriage by a helicopter transport program might be appropriate.
authors.affiliation: Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37212-1750, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Medvecz
authors.forename: J Bradford
authors.initials: JB
authors.lastname: Hill
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brywczynski
authors.forename: Oliver
authors.initials: O
authors.lastname: Gunter
authors.forename: Mario
authors.initials: M
authors.lastname: Davidson
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000552:Ambulances / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000628:therapy*; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000628:therapy*
keywords: Helicopter transport; Outcomes; Overtriage; Scene physiology