title: Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports.
abstract: OBJECTIVE
  The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries.
  
  
  METHODS
  All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included.
  
  
  RESULTS
  Of 127,489 included patients, 18,291 (14%) arrived via HEMS, compared to 56% by ground ambulance and 29% by private vehicle/walk-in. HEMS patients had more severe injuries (ISS≥25; 28% vs. 14%) and altered mental status (GCS≤8; 29% vs. 11%), but also contained many patients with only minor injuries or no major physiologic derangements. In unadjusted analysis, HEMS was associated with increased mortality (OR: 1.6; 95% CI: 1.4-1.7). However, it had decreased mortality by regression (0.5; 0.4-0.6) and propensity analysis (0.7; 0.6-0.8) to adjust for confounders.
  
  
  CONCLUSIONS
  We found multiple indicators for overuse of HEMS, with nearly 40% of children having only minor injuries. In moderate/severe injuries, HEMS is associated with decreased mortality, potentially saving one life for every 47 flights. Research is needed to determine appropriate criteria for helicopter triage.
  III.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, United States. Electronic address: brian.englum@duke.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, United States.
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Rialon
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, United States.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Division of Trauma, Duke University Medical Center, Durham, NC, United States.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
authors.affiliation: Division of Trauma, Duke University Medical Center, Durham, NC, United States.
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
authors.affiliation: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.affiliation: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States.
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Adibe
authors.affiliation: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States.
authors.forename: Elisabeth T
authors.initials: ET
authors.lastname: Tracy
mesh_terms: D000293:Adolescent; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000401:Aircraft / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D014218:Triage; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy*
keywords: Comparative effectiveness analysis; Helicopter emergency medical services; Pediatric trauma; Survival; Transport mode