Hai Sun1, Navdeep S Samra2, Piyush Kalakoti3, Kanika Sharma3, Devi Prasad Patra3, Rimal H Dossani3, Jai Deep Thakur3, Elizabeth A Disbrow4, Kevin Phan5, Sreenivas P Veeranki6, Aqueel Pabaney3, Christina Notarianni3, John T Owings2, Anil Nanda3. 1. Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. Electronic address: hsun2@lsuhsc.edu. 2. Department of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. 3. Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. 4. Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA. 5. NeuroSpine Surgery Research Group (NSURG), Barker St. Randwick, Prince of Wales Private Hospital, Sydney, Australia. 6. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Galveston, Texas, USA.
Abstract
INTRODUCTION: Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). METHODS: Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. RESULTS: Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. CONCLUSIONS: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.
INTRODUCTION: Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). METHODS: Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. RESULTS: Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. CONCLUSIONS: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.
Authors: Markus Posch; Johannes Burtscher; Gerhard Ruedl; Elena Pocecco; Martin Burtscher Journal: Int J Environ Res Public Health Date: 2022-06-24 Impact factor: 4.614
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Authors: Alberto Consuegra; Katharina Lutz; Aristomenis K Exadaktylos; Werner J Z'Graggen; Rebecca M Hasler Journal: PLoS One Date: 2022-08-17 Impact factor: 3.752