Development and Validation of the Air Medical Prehospital Triage Score for Helicopter Transport of Trauma Patients

Abstract

Objective Develop and internally validate a triage score that can identify trauma patients at the scene who would potentially benefit from helicopter emergency medical services (HEMS). Summary Background Data Although survival benefits have been shown at the population level, identification of patients most likely to benefit from HEMS transport is imperative to justify the risks and cost of this intervention. Methods Retrospective cohort study of subjects undergoing scene HEMS or ground emergency medical services (GEMS) in the National Trauma Databank (2007–2012). Data were split into training and validation sets. Subjects were grouped by triage criteria in the training set and regression used to determine which criteria had a survival benefit associated with HEMS. Points were assigned to these criteria to develop the Air Medical Prehospital Triage (AMPT) score. The score was applied in the validation set to determine if subjects triaged to HEMS had a survival benefit when actually transported by helicopter. Results There were 2,086,137 subjects included. Criteria identified for inclusion in the AMPT score included GCS<14, respiratory rate<10 or >29, flail chest, hemo/pneumothorax, paralysis, and multisystem trauma. The optimal cut-off for triage to HEMS was ≥2 points. In subjects triaged to HEMS, actual transport by HEMS was associated with an increased odds of survival (AOR 1.28; 95%CI 1.21–1.36, p<0.01). In subjects triaged to GEMS, actual transport mode was not associated with survival (AOR 1.04; 95%CI 0.97–1.11, p=0.20). Conclusions The AMPT score identifies patients with improved survival following HEMS transport and should be considered in air medical triage protocols.

External validation of the Air Medical Prehospital Triage score for identifying trauma patients likely to benefit from scene helicopter transport

“…8 We utilized the NTDB and stratified patients by presence of published trauma and air medical triage criteria in a training cohort. We then determined which criteria identify patients that have a risk-adjusted survival benefit when transported by HEMS compared to GEMS.…”

“…8 The AMPT score criteria are shown in Table 1. The score was applied to the current study population.…”

“…One limitation of the dataset used for AMPT score development is the inability to determine the level of care of prehospital providers. 8 Bias may result when comparing survival between patients transported by ground BLS providers and ALS air medical providers, as ALS providers may perform advance procedures such as invasive airway placement and intravenous resuscitation that can influence survival. Thus, we repeated the above analysis restricted to patients only treated by ALS prehospital providers.…”

“…8 It incorporates seven simple criteria adapted from existing triage guidelines to generate a point total for an individual patient and provides a triage recommendation for HEMS or GEMS transport based on patient-level factors. The AMPT score represents the first attempt at developing standardized HEMS triage criteria based on improved outcome for HEMS transport.…”

Helicopters and injured kids

“…33 The American College of Surgeons Committee on Trauma has made development of standardized evidence-based HEMS triage criteria a national priority; 45 however these efforts remain limited, even among adult trauma patients. 46-49 As this study demonstrates a survival benefit at the population-level, the next step would be to concentrate on developing triage criteria for HEMS scene transport in pediatric trauma patients that can prospectively identify patients in the field most likely to benefit from this intervention, and avoid the safety risks and unnecessary costs to the health care system.…”