NESS - Multi-Institutional comparison of Helicopter Transfers Directly to the Operating Room versus the Pit-Stop in the Emergency Department: Does it Make a Difference?

Multi-Institutional comparison of Helicopter Transfers Directly to the Operating Room versus the Pit-Stop in the Emergency Department: Does it Make a Difference?
*Gwendolyn M van der Wilden¹, *Sumbal Janjua², *Suzanne Wedel³, Suresh Agarwal⁴, *Mark Shapiro⁵, *Nicholas D Andersen⁵, *Donald Moorman⁶, *Stephen Odom⁶, *Jonathan Gates⁷, *Michael Frakes³, *Yuchiao Chang¹, George Velmahos¹, *Hasan Alam¹, *David King¹, *Marc de Moya¹
¹Massachusetts General Hospital, Boston, MA;²University of Massachusetts, Worchester, MA;³Boston Medflight, Boston, MA;⁴Boston Medical Center, Boston, MA;⁵Duke University Medical Center, Durham, NC;⁶Beth Israel Deaconess Medical Center, Boston, MA;⁷Brigham and Womens Hospital, Boston, MA

Introduction: Direct helicopter transport to the operating room for selected patients is practiced in many trauma centers to avoid unnecessary delays. However, the patterns of injury, outcomes and costs associated with this practice have not been fully described.
Methods: A multi-institutional retrospective study from 2003-2009 reviewed all trauma cases transported via helicopter directly to the operating room. Injury patterns, operative interventions, demographics and outcomes were recorded. We compared this group with a matching group of trauma patients that were transferred initially to the ED via helicopter and subsequently to the OR <1 hour. Patients transferred for craniectomy were excluded.
Results: Comparison of 22 cases and 44 controls revealed no differences in age, systolic blood pressure, or heart rate. Statistical significance was found in Glascow Coma Scale with a mean of 3.9 (cases) vs. 9.3 (controls) (p= <0.0001) and ISS with a mean of 28 (cases) vs. 21 (controls) (p=0.064). The mortality was 27.3% in cases vs. 15.9% in the controls (p=0.27). The cost analysis for the first 24 hours of admission demonstrated a mean of $25,310 (cases) vs. $23,920 (controls) (p=0.83) and $77,710 (cases) vs. $57,376 (controls) (p=0.14) for the entire length of stay.
Variable Direct to OR (22) ED to OR<1 hour (44) P-Value
ISS 28.4±14.1 21.3 ± 14.3 0.064
SBP 99.8 ± 26.6 113.1 ± 28.3 0.069
HR 96.2 ± 26.2 104.0 ± 23.1 0.31
Mortality 27.3% 15.9% 0.27
24hr Cost $25,310 ± 15,764 $23,920 ± 17,368 0.46

Conclusions: This is the first series evaluating outcomes of trauma patients transported directly to the OR from the helicopter bypassing the ED. We found no survival, hospital stay, or cost benefit in helicopter-transferred trauma patients who were transferred directly to the OR compared to those who were first taken to the ED.

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