title: Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected.
abstract: BACKGROUND
  Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground.
  
  
  METHODS
  We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality.
  
  
  RESULTS
  Of 5,202 transferred patients, 18.9% (981) were transferred via helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6).On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients.
  
  
  CONCLUSIONS
  Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system.
  
  
  METHODS
  Epidemiologic study, level III. Therapeutic study, level IV.
authors.affiliation: From the Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Vercruysse
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Irada
authors.initials: I
authors.lastname: Ibrahim-Zada
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Ammar
authors.initials: A
authors.lastname: Hashmi
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Terrence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rhee
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000191:economics / Q000706:statistics & numerical data*; D000401:Aircraft / Q000191:economics; D000552:Ambulances / Q000191:economics / Q000706:statistics & numerical data; D001130:Arizona; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies