PMID- 22929499
OWN - NLM
STAT- MEDLINE
DCOM- 20121120
LR  - 20191210
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 73
IP  - 3
DP  - 2012 Sep
TI  - Accuracy of prehospital diagnosis and triage of a Swiss helicopter emergency 
      medical service.
PG  - 709-15
LID - 10.1097/TA.0b013e31825c14b7 [doi]
AB  - BACKGROUND: Helicopter emergency medical services (HEMSs) have become a standard 
      element of modern prehospital emergency medicine. This study determines the 
      percentage of injured HEMS patients whose injuries were correctly recognized by 
      HEMS physicians. METHODS: A retrospective level III evidence prognostic study 
      using data from the largest Swiss HEMS, REGA (Rettungsflugwacht/Guarde Aerienne), 
      on adult patients with trauma transported to a Level I trauma center (January 
      2006-December 2007). National Advisory Committee on Aeronautics (NACA) scores and 
      the Injury Severity Score (ISS) were assessed to identify severely injured 
      patients. Injured body regions diagnosed by REGA physicians were compared with 
      emergency department discharge diagnoses. RESULTS: Four hundred thirty-three 
      patients were analyzed. Median age was 42.1 years (interquartile range, 
      25.5-57.9). Three hundred twenty-three (74.6%) were men. Patients were severely 
      injured, with an in-hospital NACA score of 4 or higher in 88.7% of patients and 
      median ISS of 13. REGA physicians correctly recognized injuries to the head in 
      92.9%, to the femur in 90.5%, and to the tibia/fibula in 83.8% of patients. 
      Injuries to these body regions were overdiagnosed in less than 30%. Abdominal 
      injuries were missed in 56.1%, pelvic injuries in 51.8%, spinal injuries in 
      40.1%, and chest injuries in 31.2% of patients. CONCLUSION: This study shows that 
      patients are adequately triaged by REGA physicians reflected by a NACA score 4 or 
      higher in 88.7% of patients and a median ISS of 13. However, recognition of 
      injured body regions seems to be challenging in the prehospital setting. 
      Prospective studies on specific training of HEMS physicians for recognition of 
      these injuries (e.g., portable ultrasonography, telemedicine) might help in the 
      future. LEVEL OF EVIDENCE: Prognostic study, level III.
FAU - Hasler, Rebecca M
AU  - Hasler RM
AD  - Departments of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, 
      Switzerland.
FAU - Kehl, Christian
AU  - Kehl C
FAU - Exadaktylos, Aristomenis K
AU  - Exadaktylos AK
FAU - Albrecht, Roland
AU  - Albrecht R
FAU - Dubler, Simon
AU  - Dubler S
FAU - Greif, Robert
AU  - Greif R
FAU - Urwyler, Natalie
AU  - Urwyler N
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - IM
MH  - Adult
MH  - Air Ambulances/*organization & administration
MH  - Cohort Studies
MH  - Emergency Medical Services/*standards/trends
MH  - Emergency Medicine/standards/trends
MH  - Female
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - Multiple Trauma/diagnosis/mortality/therapy
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Survival Analysis
MH  - Switzerland
MH  - Total Quality Management
MH  - Trauma Centers
MH  - Treatment Outcome
MH  - *Triage
MH  - Wounds and Injuries/*diagnosis/mortality/therapy
EDAT- 2012/08/30 06:00
MHDA- 2012/12/10 06:00
CRDT- 2012/08/30 06:00
PHST- 2012/08/30 06:00 [entrez]
PHST- 2012/08/30 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
AID - 01586154-201209000-00028 [pii]
AID - 10.1097/TA.0b013e31825c14b7 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2012 Sep;73(3):709-15. doi: 
      10.1097/TA.0b013e31825c14b7.