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Helicopter versus ground ambulance transport for interfacility transfer of critically ill children
Allan M Joseph1, Christopher M Horvat1, Idris V Evans1
1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
Insights
Helicopter transport for critically ill children is faster than ground ambulance, but does not impact mortality. Helicopter transport may reduce hospital length of stay for pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Transport medicine
- Health services research
Background:
- Critically ill children often need transfer to specialized pediatric hospitals.
- Specialized pediatric transport teams improve outcomes.
- The impact of transport mode (helicopter vs. ground ambulance) on outcomes is unclear.
Purpose of the Study:
- To investigate the association between transport mode and clinical outcomes in critically ill children.
- To compare outcomes for helicopter versus ground ambulance transport when a specialized team is used.
Main Methods:
- Retrospective cohort study design.
- Included critically ill children transferred by a specialized pediatric transport team.
- Limited analysis to patients for whom helicopter transport was initially requested, comparing those who traveled by helicopter versus ground ambulance due to non-clinical factors.
Main Results:
- Helicopter transport time was significantly shorter (143 min) than ground ambulance (289 min).
- No significant difference in in-hospital mortality between helicopter and ground ambulance transport.
- Helicopter transport was associated with a statistically significant reduction in hospital length of stay (4 days vs. 5 days).
Conclusions:
- Helicopter transport for critically ill pediatric patients without traumatic injuries is faster than ground ambulance, with a delay of approximately 2.5 hours for ground transport.
- Helicopter transport was not associated with in-hospital mortality.
- Helicopter transport may be associated with a reduced hospital length of stay.
Background:
Following initial stabilization, critically ill children often require transfer to a specialized pediatric hospital. While the use of specialized pediatric transport teams has been associated with improved outcomes for these patients, the additional influence of transfer mode (helicopter or ground ambulance) on clinical outcomes remains unknown.
Methods:
We investigated the association between transport mode and outcomes among critically ill children transferred to a single pediatric hospital via a specialized pediatric transport team. We designed a retrospective cohort study to reduce indication bias by limiting analysis to patients for whom a helicopter transport was initially requested. We compared outcomes for those who ultimately traveled via helicopter, and for those who ultimately traveled via ground ambulance due to non-clinical factors.
Results:
We compared transport times, in-hospital mortality, and hospital length of stay by transport mode. Transport time in minutes was shorter for helicopter transports (median = 143, interquartile range [IQR]: 118-184) compared to ground ambulance transports (median = 289, IQR: 213-258; difference in medians = 146, 95% CI: 12 to 168, p < 0.001). In unadjusted analysis, helicopter transport was not associated with a difference in in-hospital mortality (helicopter = 6.0%, ground ambulance = 7.0%; 95% CI for difference: -6.6% to 3.3%; p = 0.64) but was associated with a statistically significant reduction in median hospital days (helicopter = 4, ground ambulance = 5; 95% CI -3 to 0; p = 0.04). In adjusted analyses, there were no statistically significant associations. These results were consistent across sensitivity analyses.
Conclusions:
Among critically ill pediatric patients without traumatic injuries transported by a specialty team, those patients who would have been transferred by helicopter if available but were instead transferred by ground ambulance reached their site of definitive care approximately 2.5 h later. Helicopter transport for these patients was not associated with in-hospital mortality, but was potentially associated with reduced hospital length of stay.
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