Prehospital Triage of Pediatric Emergencies Treated by Helicopter Emergency Medical Services: A Population-Based Cohort Study.
Air medical journal · 2025-01-01 · Observational study
Abstract
OBJECTIVE: Helicopter emergency medical services (HEMS) play a crucial role in emergency medical services across many countries. Although some patients are discharged at the scene, most are transported to tertiary or local hospital emergency departments (EDs), with critically ill pediatric patients usually triaged to tertiary EDs. We evaluated whether critically ill pediatric patients treated by HEMS were primarily triaged to the highest level of care by comparing mortality between those admitted to tertiary versus local EDs. METHODS: We conducted a cohort study of patients aged <18 years clinically evaluated by a Danish HEMS crew during 2019-2024. The primary outcome was 30-day mortality. Secondary outcomes were National Advisory Committee for Aeronautics scores, International Classification of Diseases, 10th Revision, diagnoses, and prehospital interventions. Fisher's exact test was used for categorical comparisons. RESULTS: Of 1,104 pediatric missions, 836 patients were included. The 30-day mortality was higher in tertiary ED patients with 32 patients (5.4%) compared with 1 patient (0.4%) in the local ED group (P < .001). More tertiary ED patients had critical National Advisory Committee for Aeronautics scores (42.4% vs. 10.4%, P < .001). Injuries and Poisoning was the most common International Classification of Diseases, 10th Revision, category in the tertiary ED group, whereas Factors Influencing Health Status was the most frequent in the local ED group. Prehospital interventions were more common in the tertiary ED group (35.6% vs. 10.4%, P < .001). CONCLUSION: The 30-day mortality was higher in patients transported to tertiary EDs, indicating that HEMS crews generally triaged the most critically ill pediatric patients to the highest level of care.