Impact of transportation by Helicopter Emergency Medical Services (HEMS) to 24-hours mortality in severe traumatic brain injury
Keywords:
severe traumatic brain injury, TBI, helicopter emergency medical service, HEMSAbstract
Introduction: Patients with severe traumatic brain injury are currently transported via Helicopter Emergency Medical Services (HEMS) to provide early, specific treatment, reduce the time spent caring for patients outside the hospital, and decrease mortality.
Objective: The primary objective of this study was to determine the 24-hour mortality rate, while the secondary objectives were to assess the in-hospital mortality rate within 14 days, time to activation at the trauma center, and time to activation for emergency neurosurgery, comparing transportation by HEMS and Ground Emergency Medical Services (GEMS).
Study Method: This was a retrospective observational cohort study conducted at Nakornping Hospital from July 1st, 2017, to April 31st, 2023. The eligibility criteria included patients aged 18 years or older with severe traumatic brain injury who were transferred from a referring hospital to a receiving hospital more than 2 hours away by ambulance. Baseline characteristics, 24-hour mortality, in-hospital mortality within 14 days, and transport times in the HEMS and GEMS groups were collected. Statistical analyses were performed using multivariable logistic regression analysis.
Results: Two hundred and twenty patients were enrolled in this study. HEMS transported 40 patients, and GEMS transported 180 patients. The 24-hour mortality in the HEMS group compared with the GEMS group was not significantly different (7.5% vs. 5.56%, respectively; odds ratio 1.38, 95% CI: 0.36–5.26, p-value=0.638). However, in-hospital mortality in the HEMS group was significantly higher than in the GEMS group (30.00% vs. 11.11%, respectively; odds ratio 3.43, 95% CI: 1.51–7.79, p-value=0.003). The result of the study regarding the time to activation at the trauma center showed that HEMS was significantly faster than GEMS (158±68.5 minutes vs. 194.5±69.5 minutes, respectively; odds ratio 0.98, 95% CI: 0.97–0.99, p-value<0.001). Additionally, the time to activation for emergency neurosurgery in HEMS was also significantly shorter than in GEMS (307±69 minutes vs. 330±120 minutes, respectively; odds ratio 0.99, 95% CI: 0.98–0.99, p-value=0.045).
Conclusions: In severe traumatic brain Injury, secondary mission HEMS decreased transport time and time to emergency neurosurgery in distant hospital compared to GEMS but did not reduce 24-hour mortality rates and in-hospital mortality within 14 days.
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