Associate Professor University of Wisconsin Madison, school of medicine and public health Madison, WI, US
Introduction: Time to surgical decompression of traumatic spinal cord injury patients (tSCI) is a critical principle in managing tSCI. Although controversial, early decompression appears to be associated with improved neurological outcomes. Among the determinants of time to decompression, transport time is a major determinant that is likely impacted by mode of transport. To date, no study has compared the neurological outcomes of tSCI patients transported via: 1) ground/ambulance versus 2) air/helicopter. In this retrospective cohort study, we assess the association of the mode of transport, air versus ground transport, on the neurological outcomes of tSCI patients.
Methods: Data from tSCI patients requiring surgical decompression including 46 ground transport and 29 air transport patients was collected. American Spinal Injury Association Impairment (AIS) Grade from admission to discharge was used to assess outcomes. Additionally, the utilization of air versus ground transport was assessed based on the distance from the admitting institution.
Results: There were no significant differences (P>0.05) in patient demographics among the transport groups. Helicopter transport patients demonstrated higher rates of AIS grade improvement (P=0.004), especially among AIS grade A/grade B patients, (P=0.02; P=0.02), compared to the ambulance transport group. Additionally, within the cohort of patients undergoing decompression within 0 to 12 hours, helicopter transport was associated with higher AIS grade improvement (P=0.04) compared to the ambulance transport group. Helicopter transport was also used more frequently at distances >80 miles from the admitting institution (P=0.01).
Conclusion : The present study suggests that helicopter transport of tSCI patients requiring surgical decompression was associated with improved neurological outcomes compared to patients transported via ambulance.
