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Brendon Nafziger, DOTmed News Associate Editor | April 17, 2012
After applying these criteria to the samples in the database, the team was left with about 223,475 severely injured patients, 159,511 of whom went to level I and 63,964 to level II trauma centers. Of these patients, 61, 909 patients were transported by helicopter and 161,566 by ground vehicles.
The team then ran statistical techniques to control for potential quality differences between the trauma centers and possibly confounding patient variables. Using what's known as propensity score analysis, the researchers matched patients by vital signs, age, injury type and severity, and gender to "minimize imbalances" between them and just consider the effect the mode of transport had on their survival.
Proportionally, more patients died by helicopter, 12.6 percent (or 7,813 patients) versus 11 percent (or 17,775 patients), but Haider said this was because in general, more severely injured people were transported by helicopter.
Adjusting for patient characteristics and hospitals, the researchers found patients transported by helicopter to a level I trauma center had 16 percent increased odds of survival compared to those transported by ground. Patients going to a level II center had 15 percent better odds, he said.
Overall, you'd need to fly 65 people to a level I center to save one life, and 69 people to a level II center to save a life, Haider said. By comparison, he said for heart interventions, you must treat 333 with aspirin or 43 to 2,000 with clot-busting drugs to save a life.
Although he acknowledged it was a not a cost-effectiveness study, Haider said a rough estimate suggests that at $5,000 a flight, it would cost about $325,000 to save a life by helicopter transport compared with ground transport.
He acknowledged some limitations with the study. For one, they used retrospective data, and they had no way of knowing crew configurations in the choppers, distance the patient traveled or, for most patients, pre-hospital times.
It's also not clear what about helicopters would be helpful -- the speed, the highly trained crews who fly choppers, whom Haider said were at the "astronaut-level" of training for their field, or the intensity of care.
Haider said what's most needed now is more research and a better understanding of how the first emergency crews that arrive on a scene can triage patients.
"We need to help first responders to make the decision on whether to call the helicopter," he said.
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