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January 19, 2006 Head Injuries May Fare

Better with Helicopter Transport to Trauma Centers

By J. M. Hendry

September 2005, MERGINET—Head-injured patients, particularly those with severe

head injuries, appear to have better outcomes when transported by medical

helicopters rather than ground ambulances, according to a recently published

study.

Researchers conducted a retrospective analysis of 10,314 patients with

moderate to severe traumatic brain injury included in the San Diego County

Trauma Registry from January 1987 through December 2003. During this period,

adult major trauma patients in the San Diego County area received care at one of

five Level I or II trauma centers with advanced neurosurgical capabilities. A

minimum of two paramedics responded to such calls and helicopter crews responded

from one of two bases in the county. Medical helicopter was the primary

transport for 29 percent of the patients in this analysis.

The patients were an average age of just over 38 years and nearly 77 percent

were male. Overall, more than 40 percent were injured in a motor vehicle crash

while the remaining mechanisms of injury included gun shot wounds, assaults,

pedestrians vs. vehicles, falls or other injuries. The study group had an

average Glasgow Coma Scale (GCS) score of 9.5 and almost 52 percent were

hypotensive. Overall mortality in the patient group was 25 percent.

The investigators included variables known to affect outcome in traumatic

brain injury such as age; gender; mechanism of injury; preadmission GCS,

hypotension, head injury severity and overall injury severity in their logistic

regression analysis of outcomes associated with air vs. ground transport. They

defined good outcomes as patient discharge to home, rehabilitation with the

expectation of improvement, a psychiatric facility, jail, or leaving against

medical advice.

“Using a comprehensive logistic regression analysis, with multiple factors

important to outcome in traumatic brain injury incorporated in the model,” the

authors wrote, “we demonstrate decreased mortality and an increase in good

outcomes with use of aeromedical resources.”

“This benefit appeared to come from patients with more significant injuries,”

they added, “as defined by either preadmission Glasgow Coma Scale score or head

Abbreviated Injury Score.”

The investigators also observed better outcomes among air transported patients

who underwent out-of-hospital intubation when compared with ground transported

patients who underwent intubation after arriving at a hospital emergency

department. These results may reflect the aeromedical crews' experience with

advanced procedures and optimal ventilatory management, the authors noted.

Reference

DP. Peay J. Serrano JA Buono C. et al: “The Impact of Aeromedical

Response to Patients With Moderate to Severe Traumatic Brain Injury.” ls of

Emergency Medicine, Volume 46, Issue 2, Pages 115-122, August 2005