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Helicopter Overtriage in Pediatric Trauma

  • Maria Michailidou
    Correspondence
    Corresponding author at: Johns Hopkins University School of Medicine, Bloomberg Children’s Center, # 7354, Baltimore, MD 21287. Tel.: +1 410 955 1983; fax: +1 410 502 5314.
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • Seth D. Goldstein
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • Jose Salazar
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • Jonathan Aboagye
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • Dylan Stewart
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • David Efron
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • Fizan Abdullah
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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  • Elliot R. Haut
    Affiliations
    Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine
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Published:November 05, 2014DOI:https://doi.org/10.1016/j.jpedsurg.2014.08.008

      Abstract

      Background

      Helicopter Emergency Medical Services (HEMS) have been designed to provide faster access to trauma center care in cases of life-threatening injury. However, the ideal recipient population is not fully characterized, and indications for helicopter transport in pediatric trauma vary dramatically by county, state, and region. Overtriage, or unnecessary utilization, can lead to additional patient risk and expense. In this study we perform a nationwide descriptive analysis of HEMS for pediatric trauma and assess the incidence of overtriage in this group.

      Methods

      We reviewed records from the American College of Surgeons National Trauma Data Bank (2008-11) and included patients less than 16 years of age who were transferred from the scene of injury to a trauma center via HEMS. Overtriage was defined as patients meeting all of the following criteria: Glasgow Coma Scale (GCS) equal to 15, absence of hypotension, an Injury Severity Score (ISS) less than 9, no need for procedure or critical care, and a hospital length of stay of less than 24 hours.

      Results

      A total of 19,725 patients were identified with a mean age of 10.5 years. The majority of injuries were blunt (95.6%) and resulted from motor vehicle crashes (48%) and falls (15%). HEMS transported patients were predominately normotensive (96%), had a GCS of 15 (67%), and presented with minor injuries (ISS < 9, 41%). Overall, 28 % of patients stayed in the hospital for less than 24 hours, and the incidence of overtriage was 17%.

      Conclusions

      Helicopter overtriage is prevalent among pediatric trauma patients nationwide. The ideal model to predict need for HEMS must consider clinical outcomes in the context of judicious resource utilization. The development of guidelines for HEMS use in pediatric trauma could potentially limit unnecessary transfers while still identifying children who require trauma center care in a timely fashion.

      Key words

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      Linked Article

      • Helicopter overtriage in pediatric trauma
        Journal of Pediatric SurgeryVol. 50Issue 3
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          Helicopter Emergency Medical Services (HEMS) have been designed to provide rapid access to trauma center care in cases of life-threatening injury. However, the ideal recipient population of this resource is not fully characterized, and the indications for helicopter transport in pediatric trauma vary dramatically by county, state, and region. Overtriage, or unnecessary utilization, can lead to additional patient risk and healthcare expense. In this study we perform a nationwide descriptive analysis of HEMS for pediatric trauma and assess the incidence of overtriage in this group.
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