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The impact of a physician-staffed helicopter on outcome in patients admitted to a
stroke unit: a prospective observational study
#MMPMID28231814
Funder KS
; Rasmussen LS
; Lohse N
; Hesselfeldt R
; Siersma V
; Gyllenborg J
; Wulffeld S
; Hendriksen OM
; Lippert FK
; Steinmetz J
Scand J Trauma Resusc Emerg Med
2017[Feb]; 25
(1
): 18
PMID28231814
show ga
BACKGROUND: Transportation by helicopter may reduce time to hospital admission
and improve outcome. We aimed to investigate the effect of transport mode on
mortality, disability, and labour market affiliation in patients admitted to the
stroke unit. METHODS: Prospective, observational study with 5.5 years of
follow-up. We included patients admitted to the stroke unit the first three years
after implementation of a helicopter emergency medical services (HEMS) from a
geographical area covered by both the HEMS and the ground emergency medical
services (GEMS). HEMS patients were compared with GEMS patients. Primary outcome
was long-term mortality after admission to the stroke unit. RESULTS: Of the 1679
patients admitted to the stroke unit, 1068 were eligible for inclusion. Mortality
rates were 9.04 per 100 person-years at risk (PYR) in GEMS patients and 9.71 per
100 PYR in HEMS patients (IRR?=?1.09, 95% CI 0.79-1.49; p?=?0.60). The 30-day
mortality was 7.4% with GEMS and 7.9% with HEMS (OR?=?1.02, CI 0.53-1.96;
p?=?0.96). Incidence rate of involuntary early retirement was 6.97 per 100 PYR
and 7.58 per 100 PYR in GEMS and HEMS patients, respectively (IRR?=?1.19, CI
0.27-5.26; p?=?0.81). Work ability after 2 years and time on social transfer
payments did not differ between groups. We found no significant difference in
mean modified Rankin Scale score after 3 months (2.21 GEMS vs. 2.09 HEMS;
adjusted mean difference?=?-0.20, CI -0.74-0.33; p?=?0.46). DISCUSSION: The
possible benefit of HEMS for neurological outcome is probably difficult to detect
by considering mortality, but for the secondary analyses we had less statistical
power as illustrated by the wide confidence intervals. CONCLUSION: Helicopter
transport of stroke patients was not associated with reduced mortality or
disability, nor improved labour market affiliation compared to patients
transported by a ground unit. TRIAL REGISTRATION: The study was registered at
ClinicalTrials.gov ( NCT02576379 ).
|*Air Ambulances
[MESH]
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Aircraft
[MESH]
|Denmark/epidemiology
[MESH]
|Emergency Medical Services/*organization & administration
[MESH]
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