title: The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study.
abstract: BACKGROUND
  Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit.
  
  
  METHODS
  Prospective, observational study with 5.5 years of follow-up. We included patients admitted to the stroke unit the first three years after implementation of a helicopter emergency medical services (HEMS) from a geographical area covered by both the HEMS and the ground emergency medical services (GEMS). HEMS patients were compared with GEMS patients. Primary outcome was long-term mortality after admission to the stroke unit.
  
  
  RESULTS
  Of the 1679 patients admitted to the stroke unit, 1068 were eligible for inclusion. Mortality rates were 9.04 per 100 person-years at risk (PYR) in GEMS patients and 9.71 per 100 PYR in HEMS patients (IRR = 1.09, 95% CI 0.79-1.49; p = 0.60). The 30-day mortality was 7.4% with GEMS and 7.9% with HEMS (OR = 1.02, CI 0.53-1.96; p = 0.96). Incidence rate of involuntary early retirement was 6.97 per 100 PYR and 7.58 per 100 PYR in GEMS and HEMS patients, respectively (IRR = 1.19, CI 0.27-5.26; p = 0.81). Work ability after 2 years and time on social transfer payments did not differ between groups. We found no significant difference in mean modified Rankin Scale score after 3 months (2.21 GEMS vs. 2.09 HEMS; adjusted mean difference = -0.20, CI -0.74-0.33; p = 0.46).
  
  
  CONCLUSIONS
  The possible benefit of HEMS for neurological outcome is probably difficult to detect by considering mortality, but for the secondary analyses we had less statistical power as illustrated by the wide confidence intervals.
  
  
  CONCLUSIONS
  Helicopter transport of stroke patients was not associated with reduced mortality or disability, nor improved labour market affiliation compared to patients transported by a ground unit.
  
  
  BACKGROUND
  The study was registered at ClinicalTrials.gov ( NCT02576379 ).
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics 4231 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. milafun@hotmail.com.
authors.forename: Kamilia S
authors.initials: KS
authors.lastname: Funder
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics 4231 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics 4231 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Lohse
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics 4231 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hesselfeldt
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.affiliation: Department of Neurology, Zealand University Hospital Roskilde, Roskilde, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Gyllenborg
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics 4231 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Sandra
authors.initials: S
authors.lastname: Wulffeld
authors.affiliation: Prehospital Centre, Region Zealand, Slagelse, Denmark.
authors.forename: Ole M
authors.initials: OM
authors.lastname: Hendriksen
authors.affiliation: Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Lippert
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics 4231 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Steinmetz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017732:Air Ambulances; D000401:Aircraft; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
keywords: Disability; Helicopter emergency medical services; Labour market affiliation; Mortality; Stroke