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Helicopter overtriage in pediatric trauma.

Maria Michailidou1, Seth D Goldstein1, Jose Salazar1

  • 1Center for Pediatric Surgical Trials & Outcomes Research, Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine.

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Helicopter Emergency Medical Services (HEMS) overtriage is common in pediatric trauma, with 17% of patients deemed unnecessary transports. Developing guidelines can improve HEMS utilization for critically injured children.

Keywords:
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Area of Science:

  • Emergency Medicine
  • Pediatric Trauma Care
  • Health Services Research

Background:

  • Helicopter Emergency Medical Services (HEMS) aim to expedite trauma care for critically injured patients.
  • Indications for HEMS in pediatric trauma lack standardization, leading to regional variations.
  • Overtriage in HEMS can expose pediatric patients to unnecessary risks and increased healthcare costs.

Purpose of the Study:

  • To conduct a nationwide analysis of HEMS utilization in pediatric trauma.
  • To determine the incidence of overtriage among pediatric patients transported by HEMS.
  • To inform the development of guidelines for optimal HEMS use in pediatric trauma.

Main Methods:

  • Analysis of the American College of Surgeons National Trauma Data Bank (2008-2011).
  • Inclusion of pediatric patients (<16 years) transported by HEMS from the scene.
  • Definition of overtriage based on specific clinical and hospital stay criteria (GCS 15, no hypotension, ISS < 9, no critical procedures, <24-hour stay).

Main Results:

  • 19,725 pediatric patients were analyzed (mean age 10.5 years).
  • Most injuries were blunt (95.6%), from motor vehicle crashes (48%) and falls (15%).
  • A significant proportion of HEMS-transported pediatric patients presented with minor injuries (ISS < 9: 41%), normal GCS (67%), and normotension (96%), with 17% overtriage incidence.

Conclusions:

  • Overtriage of pediatric trauma patients by HEMS is a widespread issue nationwide.
  • Predictive models for HEMS need to balance clinical outcomes with efficient resource allocation.
  • Standardized guidelines for pediatric HEMS use are crucial to minimize unnecessary transports while ensuring timely care for those in need.