How many minutes matter: Association between time saved with air medical transport and survival in trauma patients.

IF 3.7 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2025-06-01 Epub Date: 2025-02-25 DOI:10.1097/TA.0000000000004567

Sebastian Boland, Liling Lu, David S Silver, Tamara Byrd, Francis X Guyette, Joshua B Brown

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Abstract

Background: Air medical transport (AMT) offers a survival advantage to trauma patients for several reasons, including time-savings over ground transport. Triage guidelines suggest AMT use when there are significant time-savings, but how much time needs to be saved to confer a benefit is unclear. Our objective was to define the time-savings threshold for which AMT has a survival benefit over ground transport.

Methods: Retrospective cohort of adult trauma patients transported ≤40 miles by ground or air in the Pennsylvania Trauma Outcomes Study 2000 to 2017. Geographic information system network analysis generated the counterfactual transport mode times, and we calculated a time-savings of AMT for each patient. We used restricted cubic splines to allow for non-linear effects of time-saved within multilevel logistic regression to identify a threshold of AMT time-savings associated with survival. Subgroups of patients meeting physiologic or anatomic criteria from the National Field Triage Guidelines (NFTG) and those with a positive Air Medical Prehospital Triage (AMPT) Score were analyzed.

Results: There were 280,271 patients included. The NFTG subgroup had survival advantage starting at 13 minutes of AMT time-saved (adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.30). The AMPT subgroup had survival advantage starting at 23 minutes with the greatest magnitude of improvement (adjusted odds ratio, 1.22; 95% confidence interval, 1.01-1.48). Among patients that did not meet either NFTG criteria or the AMPT score, no amount of time-saved by AMT was associated with survival ( p > 0.05). Sensitivity analysis accounting for injury severity in scene time showed the survival benefit starting at 17 minutes of AMT time-saved for the NFTG subgroup and remained 23 minutes in the AMPT subgroup.

Conclusion: Among patients meeting physiologic or anatomic NFTG criteria, a ≥ 13- to 17-minute AMT time-savings threshold was associated with improved survival. There is heterogeneity among this threshold among different patient groups that may be due to other benefits of AMT, such as advanced capabilities. These findings can inform AMT triage guidelines.

Level of evidence: Therapeutic/Care Management; Level IV.

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多少分钟至关重要：空运医疗运输节省的时间与创伤患者存活之间的关系。

背景：航空医疗运输（AMT）为创伤患者提供了生存优势，原因有几个，包括比地面运输节省时间。分诊指南建议在节省大量时间的情况下使用AMT，但需要节省多少时间才能产生效益尚不清楚。我们的目标是确定AMT比地面运输更具生存优势的时间节省阈值。方法：回顾性队列研究2000年至2017年宾夕法尼亚州创伤结局研究中陆路或空运≤40英里的成人创伤患者。地理信息系统网络分析生成了反事实的运输模式时间，我们计算了每个患者的AMT节省的时间。我们使用限制三次样条来考虑在多水平逻辑回归中节省时间的非线性效应，以确定与生存相关的AMT节省时间的阈值。分析符合国家野外分诊指南（NFTG）生理或解剖标准的患者亚组以及医院前空中医疗分诊（AMPT）评分阳性的患者。结果：共纳入280271例患者。NFTG亚组从AMT节省时间13分钟开始就有生存优势(调整优势比，1.14；95%置信区间为1.01-1.30)。AMPT亚组在23分钟开始有生存优势，改善幅度最大(调整优势比，1.22；95%置信区间，1.01-1.48)。在不符合nffg标准或AMPT评分的患者中，AMT节省的时间与生存无关（p < 0.05）。考虑现场时间损伤严重程度的敏感性分析显示，NFTG亚组的生存获益始于AMT时间的17分钟，AMPT亚组的生存获益为23分钟。结论：在符合生理或解剖NFTG标准的患者中，≥13至17分钟的AMT时间节省阈值与生存率提高相关。不同患者组之间的阈值存在异质性，这可能是由于AMT的其他益处，例如高级功能。这些发现可以为AMT分诊指南提供信息。证据水平：治疗性；IV级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.