Norah Foster (Department of Orthopaedic Surgery, Duke University Medical Center, Durham, USA) and others report in The Spine Journal that although the transfer time of patients with spinal cord injuries to a specialist trauma centre is significantly shorter with helicopter aeromedical transport systems than that of spinal cord injury patients transferred via ground transportation, helicopter transport is not associated with reduced mortality, length of stay, or less non-routine discharge.
Foster et al comment that the use of helicopter aeromedical transport systems is based on the basic belief that early definitive care improves outcomes. They add that in terms of managing patients with spinal cord injuries, preventing deterioration of neurologic function when transferring a patient to a specialist trauma centre is a “principal concern” as one study indicated that major neurological deterioration from time of injury to a specialist centre was as high as 26% (ie. the sooner the patient receives specialist care, the better). However, the authors note that there is little evidence to support the use of helicopters over ground transportation (or vice versa) as the optimum method of transferring a patient with a spinal cord injury to a specialist centre. “The aim of the study was to determine whether ground transportation for interfacility transport of patients with spinal cord injury resulted in less favourable clinical outcomes compared with helicopter aeromedical transport systems,” Foster et al write.
They performed a retrospective review of 274 patients with spinal cord injury who had been referred to their specialist trauma centre from a referring centre (between January 2006 and December 2007). Of these, 31% were transported by helicopter and 69% were transported via ground transportation. The authors found that the mean transfer time between the referring centre and their centre was significantly shorter in the patients who came via helicopter—80 minutes vs. 112 minutes for patients who came via ground transportation (p=0.001). But, after adjusting for age and injury severity score, Foster et al found that ground transportation “was not a significant predictor of in-hospital mortality, hospital length of stay, or non-routine discharge [eg. discharge to an extended care facility rather than to the patient’s home].”
They conclude: “Ground transportation for interfacility transfer of patients with spinal injury appears to be safe and suitable for patients who lack other compelling reasons for helicopter aeromedical transport systems. A prospective analysis of transportation mode in large cohort of patients is needed to verify our findings.”
“Ground transportation for the interfacility transfer of patients with spinal injury appears to be safe and suitable for patients who can be transported within 24 hours and lack other compelling reasons for helicopter medical emergency service,” Foster tells Spinal News International.