• Clay M Elswick, Deidre Wyrick, Lori A Gurien, Malik Rettiganti, Marie Gowen, Ambre' Pownall, Diaa Bahgat, R Todd Maxson, Eylem Öcal, and Gregory W Albert.
• Department of Neurosurgery, Wayne State University, Detroit, MI.
• J. Pediatr. Surg. 2018 Sep 1; 53 (9): 1795-1799.

IntroductionHelicopter emergency medical services (HEMS) have provided benefit for severely injured patients. However, HEMS are likely overused for the transportation of both adult and pediatric trauma patients. In this study, we aim to evaluate the degree of overuse of helicopter as a mode of transport for head-injured children. In addition, we propose criteria that can be used to determine if a particular patient is suitable for air versus ground transport.Materials And MethodsWe identified patients who were transported to our facility for head injuries. We included only those patients who were transported from another facility and who were seen by the neurosurgical service. We recorded a number of data points including age, gender, race, Glasgow Coma Score (GCS), and intubation status. We also collected data on a number of imaging findings such as mass effect, edema, intracranial hemorrhage, and skull fractures. Patients undergoing emergent nonneurosurgical intervention were excluded.ResultsOf the 373 patients meeting inclusion criteria, 116 (31.1%) underwent a neurosurgical procedure or died and were deemed appropriate for helicopter transport. The remaining 68.9% of patients survived their injuries without neurosurgical intervention and were deemed nonappropriate for helicopter transport. Multivariable logistic regression identified GCS 3-8 and/or presence of mass effect, edema, epidural hematoma (EDH), and open-depressed skull fracture as appropriate indications for helicopter transport.ConclusionsThe majority of patients transported to our facility by helicopter survived their head injury without need for neurosurgical intervention. Only those patients meeting clinical (GCS 3-8) or radiographic (mass effect, edema, EDH, open-depressed skull fracture) criteria should be transported by air.Level Of EvidenceLevel III (Diagnostic Study).Copyright © 2018 Elsevier Inc. All rights reserved.

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