title: Comparison of helicopter versus ground transport for the interfacility transport of isolated spinal injury.
abstract: BACKGROUND
  The use and need of helicopter aeromedical transport systems (HEMSs) in health care today is based on the basic belief that early definitive care improves outcomes. Helicopter aeromedical transport system is perceived to be safer than ground transport (GT) for the interfacility transfer of patients who have sustained spinal injury because of the concern for deterioration of neurologic function if there is a delay in reaching a higher level of care. However, the use of HEMS is facing increasing public scrutiny because of its significantly greater cost and unique risk profile.
  
  
  OBJECTIVE
  The aim of the study was to determine whether GT for interfacility transfer of patients with spinal injury resulted in less favorable clinical outcomes compared with HEMS.
  
  
  METHODS
  Retrospective review of all patients transferred to a Level 1 trauma center.
  
  
  METHODS
  Patients identified from the State Trauma Registry who were initially seen at another hospital with an isolated diagnosis of injury to the spine and then transferred to a Level 1 trauma center over a 2-year period.
  
  
  METHODS
  Neurologic deterioration, disposition from the emergency department, in-hospital mortality, interfacility transfer time, hospital length of stay, nonroutine discharge, and radiographic evidence of worsening spinal injury.
  
  
  METHODS
  Patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for injury to the spine were selected and records were reviewed for demographics and injury details. All available spine radiographs were reviewed by an orthopedic surgeon blinded to clinical data and transport type. Chi-square and t tests and multivariate linear and logistic regression models were done using STATA version 10.
  
  
  RESULTS
  A total of 274 spine injury patients were included in our analysis, 84 (31%) of whom were transported by HEMS and 190 (69%) by GT. None of the GT patients had any deterioration in neurologic examination nor any detectable alteration in the radiographic appearance of their spine injury attributable to the transportation process. Helicopter aeromedical transport system resulted in significantly less transfer time with an average time of 80 minutes compared with 112 minutes with GT (p<.001). Ultimate disposition included 175 (64%) patients discharged to home, 15 (5%) expired patients, and 84 (31%) discharged to extended care facilities. After adjusting for patient age and Injury Severity Score, the use of GT was not a significant predictor of in-hospital mortality (odds ratio, 1.4; 95% confidence interval, 0.3-5), hospital length of stay (11.2+1.3 vs. 9.5+0.8 days, p=.3), or nonroutine discharge (odds ratio, 1.1; 95% confidence interval, 0.5-2.2).
  
  
  CONCLUSIONS
  Ground transport for interfacility transfer of patients with spinal injury appears to be safe and suitable for patients who lack other compelling reasons for HEMS. A prospective analysis of transportation mode in a larger cohort of patients is needed to verify our findings.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Dr., Box 3000, Rm 5309, Duke Clinic Building, Durham, NC 27710, USA. Electronic address: norah.foster@dm.duke.edu.
authors.forename: Norah A
authors.initials: NA
authors.lastname: Foster
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 2837, Durham, NC 27710, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Elfenbein
authors.affiliation: OrthoGeorgia, 3708 Northside Drive, Macon, GA 31210, USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Kelley
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Dr., Box 3000, Rm 5309, Duke Clinic Building, Durham, NC 27710, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Brown
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 2837, Durham, NC 27710, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Foley
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 2837, Durham, NC 27710, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 2837, Durham, NC 27710, USA.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Vaslef
authors.affiliation: Department of Surgery, Duke University Medical Center, Box 2837, Durham, NC 27710, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D017732:Air Ambulances; D000552:Ambulances; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012042:Registries; D013124:Spinal Injuries; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*; D014193:Trauma Centers; D055815:Young Adult
keywords: Helicopter aeromedical transport system; Interfacility transport; Spinal injury