Diagnosis-specific patterns for direct ED discharge after physician-staffed HEMS transport in Japan: A nationwide...

Area of Science:

• Emergency Medicine
• Medical Transport Systems
• Health Services Research

Background:

• A significant number of patients transported by helicopter emergency medical services (HEMS) are discharged directly from the emergency department (ED).
• Nationwide patterns of direct ED discharge following HEMS transport, stratified by diagnosis, are not well understood.

Purpose of the Study:

• To investigate the diagnosis-specific patterns of direct ED discharge after physician-staffed HEMS transport in Japan.
• To identify demographic, clinical, and dispatch factors associated with direct ED discharge in trauma and non-trauma patients.

Main Methods:

• Retrospective analysis of patients transported by physician-staffed HEMS in Japan (April 2020-March 2023).
• Primary outcome: direct ED discharge.
• Mixed-effects logistic regression used to explore associations with patient and dispatch factors, controlling for prefecture-level variations.

Main Results:

• Direct discharge rates were 11.7% for trauma and 14.9% for non-trauma patients.
• Direct discharge varied significantly by diagnostic category for both trauma (e.g., upper extremities vs. truncal injuries) and non-trauma patients (e.g., musculoskeletal/symptom categories vs. critical organ systems).
• Younger age, female sex, pre-arrival HEMS activation, and higher Glasgow Coma Scale scores were associated with higher direct discharge likelihood in both groups. Systolic blood pressure showed differing associations between trauma and non-trauma patients.

Conclusions:

• The proportion of direct ED discharges after physician-staffed HEMS transport differs substantially across diagnostic categories for both trauma and non-trauma cases.
• These observed patterns suggest that initial diagnostic uncertainty during the pre-hospital assessment by HEMS physicians may influence direct ED discharge decisions.