HELICOPTER TRANSPORT OF INJURED CHILDREN - SYSTEM EFFECTIVENESS AND TRIAGE CRITERIA

The authors compared air and ground transport to a level I pediatric t rauma center to assess the effectiveness of helicopter transport of in jured children. They also performed a retrospective assessment of tria ge criteria and utilization patterns for helicopter transports. The sa mple comprised 3,861 children who were admitted (consecutively) to an urban level I pediatric trauma center during a 4-year period and who w ere transported by emergency medical services. TRISS probability of su rvival (P-s), z, and W scores were used to compare outcomes of ground and air transports. An absolute value of z greater than 1.96 indicates a statistically significant difference in mortality rate; the W stati stic represents the number of survivors more than expected per 100 pat ients treated. deceiver operator characteristic (ROC) curves were used to identify optimal triage criteria, using P-s < .95 to define childr en who potentially could benefit from air transport. The triage criter ia were applied to the air transport group to determine overtriage rat es. Nearly 75% of the children arrived directly from the scene of inju ry. Those transported by air were more severely injured, as shown by s ignificant differences in the mean Glasgow Coma Scale (GCS), P-s, Inju ry Severity Score, and mortality rate. The better survival rate for ch ildren transported by helicopter was indicated by a TRISS z score of 2 .81, compared with a z score of 0.31 for those transported by ambulanc e. The W statistic for the children transported by air was 1.11. ROC a nalysis identified GCS < 12 and heart rate > 160 beats per minute as o ptimal air triage criteria; these yielded 99% sensitivity and 90% spec ificity. Using these criteria, approximately 85% of air transports wou ld be considered overtriage. The authors conclude that (1) helicopter transport was associated with better survival rates among urban injure d children; (2) pediatric helicopter triage criteria based on GCS and heart rate may improve helicopter resource utilization without comprom ising care; and (3) current air triage practices result in overuse of helicopters in approximately 85% of flights. Copyright (C) 1996 by W.B . Saunders Company