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Trauma Patients Over-Triaged to Helicopter Transport in an Established Midwestern State Trauma System


Acknowledgments: The authors would like to thank Dr. Connie Rhodes and David Massop for their assistance along with Terry Smith for his assistance in acquiring trauma registry data. For further information, contact: Richard Sidwell, MD, 1415 Woodland Avenue, Suite 140, Des Moines, IA 50309–1453; e-mail:


Purpose: To characterize helicopter transport use in a mature Midwestern trauma system located in a low population density state, examine characteristics of patients over-triaged to helicopter transport, and determine predictors of over-triage to helicopter transport.

Methods: A retrospective observational study conducted using State Trauma Registry data for years 2008-2009. Study sample included patients with medical helicopter transportation. Bivariate analyses compared patients defined and not defined as over-triaged to helicopter transport. Multivariate regression was used to determine predictors of over-triage.

Findings: Of the 2,084 helicopter-transported study patients, 552 (26%) were defined as over-triaged. Differences in patients based on over-triaged status included race, age, injury mechanism, injury type, and injury intent (P < .05). Multivariate-based significant predictors of over-triage were transfer status, patient age, and injury mechanism (P= .0223; <.0001; and .0007, respectively). Patients transported from scene had a greater odds (OR: 1.29; 95% confidence interval: 1.04, 1.60) of being over-triaged to helicopter transport than interfacility transfers. Younger patients were also more likely to be over-triaged. Interactions between patient age and injury mechanism demonstrated varied likelihoods for over-triage. Younger patients injured in falls were more likely over-triaged than younger patients injured in a motor vehicle crash or by other non-fall causes.

Conclusion: Study data showed over-triage to helicopter transport was substantial in a mature trauma system. It is recommended that trauma systems develop and monitor compliance with criteria for appropriate use of air medical transport. These actions can assist in refinements to prehospital and interfacility transfer protocols.