Central nervous system trauma is the leading cause of trauma-related mortality and disability in the United States. The purpose of this research was to evaluate the association between mode of transport and the time from injury to arrival at a Trauma Center with measures of health outcomes, service utilization, and total acute care costs.
A secondary data analysis was completed on all isolated brain injured patients admitted to two Level 1 Trauma Centers with predominately rural referral areas between January 1, 1999 and December 31, 2001 (N = 1993). Variables included demographics, severity of injury measures, mortality, discharge disposition, lengths of stay in the ICU and Trauma Center, and total acute care costs. Bivariate associations were evaluated using t-tests, χ 2 , odds ratios, and simple regression. Multivariate associations were evaluated using multiple regression and multiple logistic regression.
Overall, an increase in mortality was noted for males compared to females (OR = 1.50), victims of penetrating trauma vs. blunt trauma (OR = 25.00), older patients vs. younger patients ( p < .01), and more severely injured patients as noted by a higher Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) or a lower Glasgow Coma Scale (GCS) score or motor score (p < .01 for all measures). Penetrating trauma (OR = 20.00), increased age (p < .01), and increased severity of injury ( p < .01 for all measures) were also significantly associated with being discharged to a skilled nursing facility or the morgue. No significant association was found between mode of transport or time from injury to arrival at the Trauma Center and measures of health outcomes and service utilization for mild brain injured patients. However, mild brain injured patients transported by helicopter had significantly higher total charges (p < .01). A significant reduction in mortality (OR = 0.69) and discharge to the morgue or a skilled nursing facility (OR = 0.68) was associated with helicopter transport for severe brain injured patients. Helicopter transport was associated with higher total charges ( p < .05). Controlling for severity of injury, age, and mechanism of injury, brain injured patients who were transported by ground ambulance were more than twice as likely to die as those transported by helicopter ( OR = 2.35). Multiple regression showed that helicopter transport was associated with higher total charges (p < .01) and longer ICU lengths of stay (p < .01). Time from injury to arrival at the Trauma Center had a significant inverse relationship with total patient charges (p < .05).
The benefit of helicopter transport is limited to severe brain injured patients. Use of this expensive resource should be limited to the patient population for whom it has been shown beneficial. The time interval from injury to arrival at the Trauma Center is not associated with improved health outcomes. A need exists to improve measures of severity of injury to allow for rapid and accurate identification of brain injured patients for whom advanced and aggressive clinical interventions are beneficial.
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