Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected

Gary A. Vercruysse, Randall S. Friese, Mazhar Khalil, Irada Ibrahim-Zada, Bardiya Zangbar, Ammar Hashmi, Andrew Tang, Terence OKeeffe, Narong Kulvatunyou, Donald J. Green, Lynn Gries, Bellal Joseph, Peter M. Rhee

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. METHODS We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality. RESULTS Of 5,202 transferred patients, 18.9% (981) were transferred via helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6). On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. CONCLUSION Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)510-515
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number3
DOIs
StatePublished - Mar 6 2015

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Aircraft
Delivery of Health Care
Length of Stay
Costs and Cost Analysis
Mortality
Wounds and Injuries
Propensity Score
Cost Savings
Hospital Departments
Patient Selection
Intensive Care Units
Hospital Emergency Service
Epidemiologic Studies

Keywords

  • Trauma
  • helicopter transfer
  • minimally injured

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Vercruysse, G. A., Friese, R. S., Khalil, M., Ibrahim-Zada, I., Zangbar, B., Hashmi, A., ... Rhee, P. M. (2015). Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected. Journal of Trauma and Acute Care Surgery, 78(3), 510-515. https://doi.org/10.1097/TA.0000000000000553

Overuse of helicopter transport in the minimally injured : A health care system problem that should be corrected. / Vercruysse, Gary A.; Friese, Randall S.; Khalil, Mazhar; Ibrahim-Zada, Irada; Zangbar, Bardiya; Hashmi, Ammar; Tang, Andrew; OKeeffe, Terence; Kulvatunyou, Narong; Green, Donald J.; Gries, Lynn; Joseph, Bellal; Rhee, Peter M.

In: Journal of Trauma and Acute Care Surgery, Vol. 78, No. 3, 06.03.2015, p. 510-515.

Research output: Contribution to journalArticle

Vercruysse, GA, Friese, RS, Khalil, M, Ibrahim-Zada, I, Zangbar, B, Hashmi, A, Tang, A, OKeeffe, T, Kulvatunyou, N, Green, DJ, Gries, L, Joseph, B & Rhee, PM 2015, 'Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected', Journal of Trauma and Acute Care Surgery, vol. 78, no. 3, pp. 510-515. https://doi.org/10.1097/TA.0000000000000553
Vercruysse, Gary A. ; Friese, Randall S. ; Khalil, Mazhar ; Ibrahim-Zada, Irada ; Zangbar, Bardiya ; Hashmi, Ammar ; Tang, Andrew ; OKeeffe, Terence ; Kulvatunyou, Narong ; Green, Donald J. ; Gries, Lynn ; Joseph, Bellal ; Rhee, Peter M. / Overuse of helicopter transport in the minimally injured : A health care system problem that should be corrected. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 78, No. 3. pp. 510-515.
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abstract = "BACKGROUND Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. METHODS We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality. RESULTS Of 5,202 transferred patients, 18.9{\%} (981) were transferred via helicopter and 76.7{\%} (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6). On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. CONCLUSION Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.",
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AU - Ibrahim-Zada, Irada

AU - Zangbar, Bardiya

AU - Hashmi, Ammar

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Kulvatunyou, Narong

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N2 - BACKGROUND Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. METHODS We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality. RESULTS Of 5,202 transferred patients, 18.9% (981) were transferred via helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6). On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. CONCLUSION Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.

AB - BACKGROUND Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. METHODS We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS < 5) in both the groups after propensity score matching for demographics, injury severity parameters, and admission vital parameters. Groups were then compared for hospital and emergency department length of stay, early discharge, and mortality. RESULTS Of 5,202 transferred patients, 18.9% (981) were transferred via helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6). On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. CONCLUSION Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. LEVEL OF EVIDENCE Epidemiologic study, level III. Therapeutic study, level IV.

KW - Trauma

KW - helicopter transfer

KW - minimally injured

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