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首页> 外文期刊>Prehospital emergency care >FACTORS ASSOCIATED WITH THE USE OF HELICOPTER INTER-FACILITY TRANSPORT OF TRAUMA PATIENTS TO TERTIARY TRAUMA CENTERS WITHIN AN ORGANIZED RURAL TRAUMA SYSTEM
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FACTORS ASSOCIATED WITH THE USE OF HELICOPTER INTER-FACILITY TRANSPORT OF TRAUMA PATIENTS TO TERTIARY TRAUMA CENTERS WITHIN AN ORGANIZED RURAL TRAUMA SYSTEM

机译：在农村有组织的创伤系统中使用直升机将创伤患者向种质创伤中心的设施间运输的相关因素

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Objective: A review of the literature yielded little information regarding factors associated with the decision to use ground (GEMS) or helicopter (HEMS) emergency medical services for trauma patients transferred inter-facility. Furthermore, studies evaluating the impact of inter-facility transport mode on mortality have reported mixed findings. Since HEMS transport is generally reserved for more severely injured patients, this introduces indication bias, which may explain the mixed findings. Our objective was to identify factors at referring non-tertiary trauma centers (NTC) influencing transport mode decision. Methods: This was a case-control study of trauma patients transferred from a Level III or IV NTC to a tertiary trauma center (TTC) within 24-hours reported to the Oklahoma State Trauma Registry between 2005 and 2012. Multivariable logistic regression was used to determine clinical and non-clinical factors associated with the decision to use HEMS. Results: A total of 7380 patients met the study eligibility. Of these, 2803(38%) were transported inter-facility by HEMS. Penetrating injury, prehospital EMS transport, severe torso injury, hypovolemic shock, and TBI were significant predictors (p<0.05) of HEMS use regardless of distance to a TTC. Association between HEMS use and male gender, Level IV NTC, and local ground EMS resources varied by distance from the TTC. Many HEMS transported patients had minor injuries and normal vital signs. Conclusions: Our results suggest that while distance remains the most influential factor associated with HEMS use, significant differences exist in clinical and non-clinical factors between patients transported by HEMS versus GEMS. To ensure comparability of study groups, studies evaluating outcome differences between HEMS and GEMS should take factors determining transport mode into account. The findings will be used to develop propensity scores to balance baseline risk between GEMS and HEMS patients for use in subsequent studies of outcomes.
机译：目的：对文献的回顾几乎没有得出与决定将地面（GEMS）或直升机（HEMS）紧急医疗服务用于跨机构转移的创伤患者的决定有关的因素的信息。此外，评估机构间运输方式对死亡率影响的研究报告了不同的发现。由于HEMS运输通常只供重伤较重的患者使用，因此引入了适应症，这可能解释了混合的发现。我们的目标是确定影响非三重创伤中心（NTC）的影响运输方式决策的因素。方法：这是一项病例对照研究，研究对象是2005年至2012年间在俄克拉荷马州创伤登记处报告的24小时内从III级或IV级NTC转移到第三级创伤中心（TTC）的创伤患者。采用多变量logistic回归分析确定与决定使用HEMS相关的临床和非临床因素。结果：共有7380名患者符合研究资格。其中，有2803个（38％）通过HEMS在工厂间运输。穿透伤，院前EMS运输，严重躯干损伤，低血容量性休克和TBI是HEMS使用的重要预测因素（p <0.05），而与距TTC的距离无关。 HEMS使用与男性，IV级NTC和当地地面EMS资源之间的关联因距TTC的距离而异。许多接受HEMS转运的患者轻伤，生命体征正常。结论：我们的结果表明，尽管距离仍然是与HEMS使用相关的最有影响力的因素，但HEMS与GEMS转运的患者之间在临床和非临床因素上存在显着差异。为了确保研究组的可比性，评估HEMS和GEMS之间结果差异的研究应考虑确定运输方式的因素。该发现将用于建立倾向评分，以平衡GEMS和HEMS患者之间的基线风险，以用于后续的结局研究。

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