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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Article info
Publication history
Published online: November 05, 2014
Accepted:
August 12,
2014
Received:
August 8,
2014
Footnotes
☆Presented at Templeton Conference.
Identification
Copyright
© 2014 Published by Elsevier Inc.
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Access this article on ScienceDirectLinked Article
- Helicopter overtriage in pediatric traumaJournal of Pediatric SurgeryVol. 50Issue 3
- PreviewHelicopter 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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