Do Trauma Patients Aged 55 and Older Benefit from Air Medical Transport?

Werman, Howard A.; Darbha, Subrahmanyam; Cudnik, Michael T.; Caterino, Jeffrey M.

doi:10.1080/10903127.2016.1269223

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…This impact on survival is despite early and aggressive intensive care. In this analysis, it is not possible to separate contributing risk of co-morbidity or factors before the critical care and transport episode, something that might be a signi cant contributor to mortality both in air ambulance transportation and in the ICU (8)(9)(10)(11). The relative mortality risks for cases with these conditions is in general agreement with those presented in some recent reports for shorter distance, rotary-wing ambulance, primary transports with ICU character (4,12).…”

Section: Discussionsupporting

confidence: 79%

Impaired oxygenation and hemodynamic instability are independent predictors of long-term mortality in a regional cohort needing urgent fixed-wing intensive care transport to tertiary care

Sundbom¹,

Sangfelt²,

Lindgren³

et al. 2020

Preprint

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Background We aimed to test if impaired oxygenation or major hemodynamic instability at the time of emergency intensive care transport between hospitals are predictors of long-term mortality.Methods From a regional hospital intensive care transport research database, the study cohort was identified as those emergency intensive care cases transported in fixed-wing air ambulance from outlying hospitals to a regional tertiary care center during 2000–2016 for adults (16 years old or older). Impaired oxygenation was defined as oxyhemoglobin % - inspired oxygen fraction ratio (S/F ratio) < 100. Major hemodynamic instability was defined as need for treatment with noradrenaline infusion to sustain mean arterial pressure (MAP) at or above 60 mmHg or having a mean MAP < 60. All-cause mortality at 3 months after transport was the primary outcome, and secondary outcomes were all-cause mortality at 6 and 12 months. Multivariate cumulative survival and hazard analysis was performed for intervals 3, 6 and 12 months.Results There were 2142 patients included in the analysis. The S/F ratio < 100 was associated with increased mortality risk compared to S/F > 300 at all time-points, with hazard ratio (HR) 2.9 (1.9–4.4 95% CI, p < 0.001) at 12 months. Major hemodynamic instability during ICU transport was associated with increased HR of all-cause mortality up to one year with hazard ratio 1.9 (1.5–2.5, p < 0.001).Conclusion Major impairment of oxygenation and/or major hemodynamic instability at the time of ICU transport to get to urgent tertiary intervention is strongly associated with reduced survival at least up to one year after the transport, in this cohort. These findings support the conclusion that these conditions are markers for many fold increase in risk for death notable already at 3 months after transport for patients with these conditions. How much this risk is modifiable is not assessable in this analysis.

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Section: Discussionsupporting

confidence: 79%

Impaired oxygenation and hemodynamic instability are independent predictors of long-term mortality in a regional cohort needing urgent fixed-wing intensive care transport to tertiary care

Sundbom¹,

Sangfelt²,

Lindgren³

et al. 2020

Preprint

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“…Five studies with low to moderate risk of bias evaluated comorbidities including alcohol use and their association with serious injury or mortality from traumatic injuries, with studies with available LRs reported in Table 5. These studies found congestive heart failure (LR+ 3.1), 45 prior cerebrovascular accident at any age (LR+ 2.5) or age ≥ 60 years (LR+ 3.0), 45 chronic kidney disease and a fall mechanism with age ≥ 65 years (aOR 2.5 [95% CI 1.85–3.33]), 46 a cardiac history and older age (age ≥ 55 years aOR 1.66 [95% CI 1.28–2.15] and age ≥ 70 years aOR 1.77 [95% CI 1.31–2.39]), 47 and alcohol use (aOR 3.10 [95% CI 2.94–3.26]) 19 were significantly associated with mortality. The presence of any comorbidity 4 or two or more comorbidities 47 regardless of specific comorbidity type was not strongly predictive of serious injury (LR+ 1.1) 4 or significant adjusted odds for mortality 47 .…”

Section: Resultsmentioning

confidence: 99%

“…These studies found congestive heart failure The presence of any comorbidity4 or two or more comorbidities 47 regardless of specific comorbidity type was not strongly predictive of serious injury (LR+ 1.1) 4 or significant adjusted odds for mortality 47. There were no studies specifically on child or elder abuse, interpersonal violence, or pregnancy as predictors of injury severity.…”

mentioning

confidence: 99%

Mechanism of injury and special considerations as predictive of serious injury: A systematic review

Lupton

Davis-OʼReilly

Jungbauer

et al. 2022

Academic Emergency Medicine

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Objectives:The Centers for Disease Control and Prevention's field triage guidelines (FTG) are routinely used by emergency medical services personnel for triaging injured patients. The most recent (2011) FTG contains physiologic, anatomic, mechanism, and special consideration steps. Our objective was to systematically review the criteria in the mechanism and special consideration steps that might be predictive of serious injury or need for a trauma center. Methods:We conducted a systematic review of the predictive utility of mechanism and special consideration criteria for predicting serious injury. A research librarian searched in Ovid Medline, EMBASE, and the Cochrane databases for studies published between January 2011 and February 2021. Eligible studies were identified using a priori inclusion and exclusion criteria. Studies were excluded if they lacked an outcome for serious injury, such as measures of resource use, injury severity scores, mortality, or composite measures using a combination of outcomes. Given the heterogeneity in populations, measures, and outcomes, results were synthesized qualitatively focusing | 1107 LUPTON et al.

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“…Further analyses of age groups reveal survival benefits for HEMS transport in patients ≤ 75 years, while survival appears lower in those older than 75 years, similar to findings from other groups. 18 Thus, rather than including a specific age criterion, it may be more appropriate to consider applying the AMPT score only in patients ≤ 75 years, while those >75 years undergo ground transport. However, these age analyses are exploratory and require further directed study to establish what, if any, age range restriction may be appropriate for HEMS transport after trauma.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Do Trauma Patients Aged 55 and Older Benefit from Air Medical Transport?

Abstract: Our study was able to demonstrate a survival benefit for the cohort of patients age greater than 55 years of age. Key words: air medical transport; trauma; geriatric.

Cited by 6 publications

References 14 publications

Impaired oxygenation and hemodynamic instability are independent predictors of long-term mortality in a regional cohort needing urgent fixed-wing intensive care transport to tertiary care

Impaired oxygenation and hemodynamic instability are independent predictors of long-term mortality in a regional cohort needing urgent fixed-wing intensive care transport to tertiary care

Mechanism of injury and special considerations as predictive of serious injury: A systematic review

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

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