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Helicopter transport of injured children: system effectiveness and triage criteria
M L Moront1, C S Gotschall, M R Eichelberger
1Department of Surgery, Children's National Medical Center, Washington, DC 20010-2970, USA.
Insights
Helicopter transport improves survival for critically injured children. New triage criteria using Glasgow Coma Scale and heart rate could optimize helicopter use and reduce unnecessary flights.
Area of Science:
- Pediatric trauma care
- Emergency medical services
- Transport medicine
Background:
- Assessing the effectiveness of helicopter transport for injured children is crucial for optimizing trauma care.
- Understanding triage criteria and utilization patterns for helicopter transports is essential for resource management.
Purpose of the Study:
- To compare the effectiveness of air versus ground transport for injured children to a pediatric trauma center.
- To retrospectively assess triage criteria and utilization patterns for helicopter transports.
Main Methods:
- A retrospective analysis of 3,861 consecutively admitted children transported by emergency medical services to an urban level I pediatric trauma center over 4 years.
- TRISS (Trauma and Injury Severity Score) and ROC (Receiver Operator Characteristic) curve analyses were used to compare outcomes and identify optimal triage criteria.
Main Results:
- Children transported by air were more severely injured (higher Injury Severity Score, lower Glasgow Coma Scale, higher mortality rate) but had a better survival rate (TRISS z score of 2.81 for air vs. 0.31 for ground).
- Optimal air triage criteria (Glasgow Coma Scale < 12 and heart rate > 160 bpm) demonstrated 99% sensitivity and 90% specificity.
- Applying these criteria indicated that approximately 85% of current air transports may be overtriage.
Conclusions:
- Helicopter transport is associated with improved survival rates for urban pediatric trauma patients.
- Developing pediatric helicopter triage criteria based on Glasgow Coma Scale and heart rate can enhance resource utilization without compromising patient care.
- Current air triage practices lead to significant overtriage, suggesting a need for refined protocols.
Abstract:
The authors compared air and ground transport to a level I pediatric trauma center to assess the effectiveness of helicopter transport of injured children. They also performed a retrospective assessment of triage criteria and utilization patterns for helicopter transports. The sample comprised 3,861 children who were admitted (consecutively) to an urban level I pediatric trauma center during a 4-year period and who were transported by emergency medical services. TRISS probability of survival (P2),z, and W scores were used to compare outcomes of ground and air transports. An absolute value of z greater than 1.96 indicates a statistically significant difference in mortality rate; the W statistic represents the number of survivors more than expected per 100 patients treated. Receiver operator characteristic (ROC) curves were used to identify optimal triage criteria, using P6 < .95 to define children who potentially could benefit from air transport. The triage criteria were applied to the air transport group to determine overtriage rates. Nearly 75% of the children arrived directly from the scene of injury. Those transported by air were more severely injured, as shown by significant differences in the mean Glasgow Coma Scale (GCS), P6, Injury Severity Score, and mortality rate. The better survival rate for children transported by helicopter was indicated by a TRISS z score of 2.81, compared with a z score of 0.31 for those transported by ambulance. The W statistic for the children transported by air was 1.11. ROC analysis identified GCS < 12 and heart rate > 160 beats per minute as optimal air triage criteria; these yielded 99% sensitivity and 90% specificity. Using these criteria, approximately 85% of air transports would be considered overtriage. The authors conclude that (1) helicopter transport was associated with better survival rates among urban injured children; (2) pediatric helicopter triage criteria based on GCS and heart rate may improve helicopter resource utilization without compromising care; and (3) current air triage practices result in overuse of helicopters in approximately 85% of flights.