The Effect of Transport Altitude on Outcomes in Traumatic Brain Injury: The HEIGHT-TBI Study

Q3 Nursing

Air Medical Journal Pub Date : 2025-08-21 DOI:10.1016/j.amj.2025.06.007

Vasisht Srinivasan MD, FACEP , Courtney Gomez MD , Jane Hall PhD , Kyle Danielson MPH, MN, ARNP , Abhijit Lele MBBS, MD, MSCR, FNCS , Richard Utarnachitt MD , Andrew Latimer MD , Bryce Robinson MD

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Abstract

Background and Purpose

Many patients with traumatic brain injury (TBI) require aeromedical transport to trauma centers for specialized care. However, the effects of flight on TBI patients have not been previously studied. We examined how altitude influences outcomes in adult TBI patients who required helicopter transport to the regional trauma center.

Methods

State trauma registry and aeromedical transport records were retrospectively reviewed to identify TBI patients flown to the regional level I trauma center over a five-year period (2017 – 2022). Multivariable logistic regression was performed to evaluate associations between the coprimary exposures (altitude and flight duration) and coprimary outcomes (in-hospital mortality and percentage of patients discharged to home versus skilled nursing facilities) while adjusting for patient characteristics and injury severity. Secondary analyses examined interactions between hypotension and altitude.

Results

1,010 flights and 1,007 patients were identified (age: 53.6 ± 21.5 years; sex: 30.7% women; race: 90.1% white) with mean flight duration of 22.8 ± 11 mins and median altitude of 2200 ± 1300 ft. Hypoxemia (SpO2 < 94%) was observed in 29.5% of transports, and hypotension (SBP < 110 mmHg) in 34.9%. In-hospital all-cause mortality was 17.4% (N=175) and 54% (N=544) were discharged home. The main analyses showed increased mortality and discharge to SNF versus home associated with flights above 6,000 ft for all comers (adjusted OR=4.3, 95% CI: 1.1–16.5; aOR=3.2; 95% CI: 1.1–9.6, respectively). Secondary analyses suggested concomitant hypotension was associated with poorer outcomes at all higher altitudes starting at 1,500-3,000 ft, compared to flights below 1,500 ft (adjusted OR=4.4, 95% CI: 2.3–8.6; aOR=2.7; 95% CI: 1.6–4.5, respectively).

Conclusion

Transport altitude may affect mortality in TBI and compound the deleterious effects of hypotension. Further study is needed for better understanding of the effects of hypobaric transport and the implications for acute brain injury.

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运输海拔对外伤性脑损伤预后的影响：高度- tbi研究

背景与目的许多创伤性脑损伤（TBI）患者需要空运到创伤中心接受专门护理。然而，飞行对创伤性脑损伤患者的影响尚未被研究过。我们研究了海拔如何影响需要直升机运送到区域创伤中心的成年TBI患者的预后。方法回顾性分析国家创伤登记和航空医疗运输记录，以确定在五年内（2017 - 2022年）飞往地区一级创伤中心的TBI患者。在调整患者特征和损伤严重程度的同时，采用多变量logistic回归来评估主要暴露（海拔高度和飞行时间）和主要结局（住院死亡率和出院回家与熟练护理机构的患者百分比）之间的关联。二次分析检查低血压和海拔之间的相互作用。结果共发现1010例航班和1007例患者（年龄：53.6±21.5岁，性别：30.7%女性，种族：90.1%白人），平均飞行时间22.8±11分钟，中位海拔2200±1300英尺。29.5%的航班出现低氧血症（SpO2 < 94%）， 34.9%的航班出现低血压（收缩压<； 110 mmHg）。院内全因死亡率为17.4% (N=175), 54% （N=544）出院回家。主要分析显示，与家中相比，所有入境者的死亡率和SNF排放与飞行高度在6000英尺以上相关（调整后OR=4.3, 95% CI: 1.1-16.5; aOR=3.2; 95% CI: 1.1-9.6）。二次分析表明，与1500英尺以下的飞行相比，在1500 - 3000英尺的所有高海拔地区，伴随低血压的预后较差（调整后OR=4.4, 95% CI: 2.3-8.6; aOR=2.7; 95% CI: 1.6-4.5）。结论运输海拔可能影响TBI患者的死亡率，并加重低血压的不良影响。需要进一步研究以更好地了解低压转运的影响及其对急性脑损伤的影响。

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

Air Medical Journal Nursing-Emergency Nursing

CiteScore

1.20

自引率

0.00%

发文量

112

审稿时长

69 days

期刊介绍： Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.