Current use and outcomes of helicopter transport in pediatric trauma: a review of 18,291 transports

Purpose: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. Methods: All blunt/penetrating trauma patients <18 years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS) > 9 were included. Results: Of 127,489 included patients, 18,291 (14%) arrived via HEMS, compared to 56% by ground ambulance and 29% by private vehicle/walk-in. HEMS patients had more severe injuries (ISS >= 25; 28% vs. 14%) and altered mental status (GCS <= 8; 29% vs. 11%), but also contained many patients with only minor injuries or no major physiologic derangements. In unadjusted analysis, HEMS was associated with increased mortality (OR: 1.6; 95% Cl: 1.4-1.7). However, it had decreased mortality by regression (0.5; 0.4-0.6) and propensity analysis (0.7; 0.6-0.8) to adjust for confounders. Conclusion: We found multiple indicators for overuse of HEMS, with nearly 40% of children having only minor injuries. In moderate/severe injuries, HEMS is associated with decreased mortality, potentially saving one life for every 47 flights. Research is needed to determine appropriate criteria for helicopter triage. (C) 2017 Elsevier Inc. All rights reserved.