Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury

Hai Sun, Navdeep S. Samra, Piyush Kalakoti, Kanika Sharma, Devi Prasad Patra, Rimal H. Dossani, Jai Deep Thakur, Elizabeth A. Disbrow, Kevin Phan, Sreenivas P. Veeranki, Aqueel Pabaney, Christina Notarianni, John T Owings, Anil Nanda

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). Methods: Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. Results: Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. Conclusions: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Mar 30 2017

Fingerprint

Aircraft
Numbers Needed To Treat
Survival
Emergency Medical Services
Propensity Score
Odds Ratio
Confidence Intervals
Skiing
Statistical Data Interpretation
Traumatic Brain Injury
Statistical Models
Logistic Models
Databases
Mortality
Wounds and Injuries

Keywords

  • NTDB
  • Prehospital transport
  • Skiers
  • Snowboarders
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Sun, H., Samra, N. S., Kalakoti, P., Sharma, K., Patra, D. P., Dossani, R. H., ... Nanda, A. (Accepted/In press). Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury. World Neurosurgery. https://doi.org/10.1016/j.wneu.2017.05.108

Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury. / Sun, Hai; Samra, Navdeep S.; Kalakoti, Piyush; Sharma, Kanika; Patra, Devi Prasad; Dossani, Rimal H.; Thakur, Jai Deep; Disbrow, Elizabeth A.; Phan, Kevin; Veeranki, Sreenivas P.; Pabaney, Aqueel; Notarianni, Christina; Owings, John T; Nanda, Anil.

In: World Neurosurgery, 30.03.2017.

Research output: Contribution to journalArticle

Sun, H, Samra, NS, Kalakoti, P, Sharma, K, Patra, DP, Dossani, RH, Thakur, JD, Disbrow, EA, Phan, K, Veeranki, SP, Pabaney, A, Notarianni, C, Owings, JT & Nanda, A 2017, 'Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury', World Neurosurgery. https://doi.org/10.1016/j.wneu.2017.05.108
Sun, Hai ; Samra, Navdeep S. ; Kalakoti, Piyush ; Sharma, Kanika ; Patra, Devi Prasad ; Dossani, Rimal H. ; Thakur, Jai Deep ; Disbrow, Elizabeth A. ; Phan, Kevin ; Veeranki, Sreenivas P. ; Pabaney, Aqueel ; Notarianni, Christina ; Owings, John T ; Nanda, Anil. / Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury. In: World Neurosurgery. 2017.
@article{2b5abe1816a9487088725b13e895dce8,
title = "Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury",
abstract = "Introduction: Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). Methods: Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. Results: Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4{\%}) were transported via helicopters whereas 658 (64.6{\%}) via ground EMS with a mortality rate of 1.7{\%} and 1.5{\%}, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95{\%} confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06{\%}). This finding persisted after propensity score matching (odds ratio 24.73; 95{\%} confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. Conclusions: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.",
keywords = "NTDB, Prehospital transport, Skiers, Snowboarders, Traumatic brain injury",
author = "Hai Sun and Samra, {Navdeep S.} and Piyush Kalakoti and Kanika Sharma and Patra, {Devi Prasad} and Dossani, {Rimal H.} and Thakur, {Jai Deep} and Disbrow, {Elizabeth A.} and Kevin Phan and Veeranki, {Sreenivas P.} and Aqueel Pabaney and Christina Notarianni and Owings, {John T} and Anil Nanda",
year = "2017",
month = "3",
day = "30",
doi = "10.1016/j.wneu.2017.05.108",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Impact of Prehospital Transportation on Survival in Skiers and Snowboarders with Traumatic Brain Injury

AU - Sun, Hai

AU - Samra, Navdeep S.

AU - Kalakoti, Piyush

AU - Sharma, Kanika

AU - Patra, Devi Prasad

AU - Dossani, Rimal H.

AU - Thakur, Jai Deep

AU - Disbrow, Elizabeth A.

AU - Phan, Kevin

AU - Veeranki, Sreenivas P.

AU - Pabaney, Aqueel

AU - Notarianni, Christina

AU - Owings, John T

AU - Nanda, Anil

PY - 2017/3/30

Y1 - 2017/3/30

N2 - Introduction: Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). Methods: Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. Results: Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. Conclusions: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.

AB - Introduction: Prehospital helicopter use and its impact on outcomes in snowboarders and skiers incurring traumatic brain injury (TBI) is unknown. The present study investigates the association of helicopter transport with survival of snowboarders and skiers with TBI, in comparison with ground emergency medical services (EMS), by using data derived from the National Trauma Data Bank (2007-2014). Methods: Primary and secondary endpoints were defined as in-hospital survival and absolute risk reduction based upon number needed to transport (treat) respectively. Multivariable regression models including traditional logit model, model fitted with generalized estimating equations, and those incorporating results from propensity score matching methods were used to investigate the association of helicopter transport with survival compared with ground EMS. Results: Of the 1018 snowboarders and skiers who met the criteria, 360 (35.4%) were transported via helicopters whereas 658 (64.6%) via ground EMS with a mortality rate of 1.7% and 1.5%, respectively. Multivariable log-binomial models demonstrated association of prehospital helicopter transport with increased survival (odds ratio 8.58; 95% confidence interval 1.09-67.64; P = 0.041; absolute risk reduction: 10.06%). This finding persisted after propensity score matching (odds ratio 24.73; 95% confidence interval 5.74-152.55; P < 0.001). The corresponding absolute risk reduction implies that approximately 10 patients need to be transported via helicopter to save 1 life. Conclusions: Based on our robust statistical analysis of retrospective data, our findings suggest prehospital helicopter transport improved survival in patients incurring TBI after snowboard- or ski-related falls compared with those transported via ground EMS. Policies directed at using helicopter services at remote winter resorts or ski or snowboarding locations should be implemented.

KW - NTDB

KW - Prehospital transport

KW - Skiers

KW - Snowboarders

KW - Traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=85021156854&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021156854&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2017.05.108

DO - 10.1016/j.wneu.2017.05.108

M3 - Article

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -