Transport Mode to Level I and II Trauma Centers and Survival of Pediatric Patients with Traumatic Brain Injury

Abstract

The use of helicopter emergency medical services (EMS) for pediatric trauma patients is an issue of debate. We investigated the association of helicopter transport with survival of pediatric patients with traumatic brain injury (TBI). We conducted a retrospective cohort study of pediatric patients with TBI who were transported to level I and II trauma centers and were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011. We used regression techniques, integrating the results of propensity score matching, to investigate the association of helicopter transport with survival, in comparison with ground EMS. There were 15,704 pediatric patients with TBI who met the inclusion criteria. Of these, 3142 were transported via helicopters, and 12,562 via ground EMS. The mortality for children transported to level I trauma centers was 7.5% (183 deaths) for helicopter transport and 3.8% (337 deaths) for ground. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.27–2.46; absolute risk reduction [ARR], 2.70%). This persisted after propensity score matching (OR, 1.77; 95% CI, 1.25–2.52; ARR 2.73%). The mortality for children transported to level II trauma centers was 8.0% (52 deaths) for helicopter transport, and 4.4% (163 deaths) for ground. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival (OR, 2.35; 95% CI, 1.30–4.25; ARR 5.36%). This again persisted after propensity score matching (OR 2.56; 95% CI 1.28–5.11; ARR 6.14). Pediatric patients with TBI transported to level I and II trauma centers had improved survival in comparison with similar patients transported via ground EMS.