Interfacility Ambulance Versus Helicopter Transport of Traumatic Spinal Cord Injury Patients: Outcomes, Observations, and Utilization.

Abstract

Introduction: Traumatic spinal cord injury (tSCI) is a devastating event that can cause permanent loss of function or disability. Time to surgical decompression of the spinal cord affects outcomes and is a critical principle in management of tSCI. One of the major determinants of time to decompression is transport time. To date, no study has compared the neurological outcomes of tSCI patients transported via ground/ambulance versus air/helicopter.

Objective: This retrospective cohort study sought to assess the association of the mode of transport on the neurological outcomes of tSCI patients.

Methods: Data from 46 ground transport and 29 air transport patients with tSCI requiring surgical decompression were collected. Outcomes were assessed by the change in American Spinal Injury Association Impairment Scale (AIS) grade from admission to discharge. Additionally, the utilization of air versus ground transport was assessed based on the distance from the admitting institution.

Results: Among the transport groups, there were no significant differences (PP  < 0.05) in patient demographics. Helicopter transport patients demonstrated higher rates of AIS grade improvement (P  = 0.004), especially among AIS grade A/grade B patients (P   = 0.02; P   = 0.02, respectively), compared to the ambulance transport group. Additionally, within the cohort of patients undergoing decompression within 0 to 12 hours, helicopter transport was associated with higher AIS grade improvement (P  = 0.04) versus the ambulance transport group. Helicopter transport was used more frequently at distances greater than 80 miles from the admitting institution (P  = 0.01).

Conclusions: This study suggests that helicopter transport of tSCI patients requiring surgical decompression was associated with improved neurological outcomes compared to patients transported via ambulance.