Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre.

BACKGROUND: Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. METHODS: We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. RESULTS: Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33-0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. CONCLUSION: Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport.

CONTEXTE: Le transport par ambulance aérienne pour les polytraumatisés est d'une importance vitale compte tenu du volume croissant de patients, du nombre limité de centres de traumatologie et des effectifs insuffisants en médecine de spécialité dans les hôpitaux dépourvus d'unités de traumatologie. Les services de transport ambulanciers aériens ont la capacité d'améliorer les résultats chez les patients, comparativement au transport terrestre dans certaines situations. Notre objectif principal était de comparer les traumatismes, les interventions et les résultats chez les patients transportés par hélicoptère ou autrement. MÉTHODES: Nous avons procédé à une revue rétrospective sur 10 ans du transport de 14 440 patients vers un centre urbain de traumatologie de niveau 1 par hélicoptère ou autrement. Nous avons comparé la gravité des blessures, les interventions et la mortali té entre les groupes. RÉSULTATS: Les patients transportés par hélicoptère présentaient des indices médians de gravité des blessures plus élevés, indépendamment de la nature ouverte ou fermée des blessures, et ils étaient plus susceptibles de présenter un score inférieur à 8 sur l'échelle de Glasgow, de nécessiter une intubation, de recevoir des transfusions sanguines et d'être admis aux soins intensifs ou au bloc opératoire, comparativement aux patients transportés autrement. Le transport par hélicoptère a été associé à une mortalité globale moins élevée (rapport des cotes 0,41; intervalle de confiance de 95 % 0,33­0,39). Les patients transportés autrement étaient plus susceptibles de mourir à l'urgence. Le score moyen de gravité des blessures, indépendamment du moyen de transport, est passé de 12,3 à 15,1 (p = 0,011) durant la période de l'étude. CONCLUSION: Les patients transportés par hélicoptère vers un centre de traumatologie urbain étaient plus grièvement blessés, nécessitaient plus d'interventions et leur survie a été meilleure que celle des patients transportés autrement.

Prospective randomized study of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated Dacron (Hemashield) patching: perioperative (30-day) results.

PURPOSE: Several studies have reported that carotid endarterectomy (CEA) with patch angioplasty has results that are superior to primary closure. Polytetrafluoroethylene (PTFE) patching has been shown to have results comparable with autogenous vein patching; however, it requires a prolonged hemostasis time. Therefore, many surgeons are using collagen-impregnated Dacron patching (Hemashield [HP]). This study is the first prospective randomized trial comparing CEA with PTFE patching versus HP patching. METHODS: Two hundred CEAs were randomized into two groups, 100 PTFE and 100 HP patching. All patients underwent immediate postoperative and 1-month postoperative color duplex ultrasound scanning studies. Demographic and clinical characteristics were similar in both groups, including the mean operative diameter of the internal carotid artery. RESULTS: The perioperative stroke rates were 0% for PTFE, versus 7% for HP (4 major and 3 minor strokes, P =.02). The combined perioperative stroke and transient ischemic attack rates were 3% for PTFE, versus 12% for HP (P =.047). The operative mortality rate for PTFE was 0%, versus 2% for HP (P =.477). Five perioperative carotid thromboses were noted in patients undergoing HP patching, versus none in patients undergoing PTFE patching (P =.07). After 1 month of follow-up, 2% of patients in the PTFE group had a 50% or more restenosis, versus 12% of patients in the HP group (P =.013). The mean operative time for PTFE patching was 119 minutes, versus 113 minutes for HP patching (P =.081). The mean hemostasis time was significantly higher for PTFE patching than for HP patching, 14.4 versus 3.4 minutes (P <.001). CONCLUSION: CEA with HP patching had a higher incidence of perioperative strokes, carotid thrombosis, and 50% or more early restenosis than CEA with PTFE patching. However, the mean hemostasis time was higher for PTFE patching than for HP patching.