Impact of a routine neurosurgical dispatch on emergency air medical transport and outcome of patients with intracranial hemorrhage

Wen Ya Tung, Julia Chia-Yu Chang, Chung Yeh Deng, Yang Shin Shih, David Hung-Tsang Yen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background/Purpose: Emergency air medical transport (EAMT) of patients in remote areas with neurological emergencies to higher-level facilities is an integral part of the regionalized healthcare system. EAMT is safe and feasible for head injuries. Debates persist on the high cost, safety, and risk of EAMT, thereby calling for alternatives. Methods: We conducted a retrospective cohort study by including all patients with intracranial hemorrhage (ICH) who visited the Kinmen Hospital from January 2006 to December 2016. Routine neurosurgical dispatch (RNSD) implemented since 2009, dispatches neurosurgeons to Kinmen. EAMT and 90-day mortality were assessed. Results: We enrolled 560 patients: 173 pre-stage and 387 post-stage. RNSD resulted in less EAMT deployment ([adjusted odds ratio AOR] = 0·23, p < 0·001) and lower 90-day mortality ([adjusted hazard ratio AHR] 0·66, p = 0·043). RNSD resulted in decreased EAMT among all subgroups, especially in age ≥81 years (AOR 0.03, p < 0.001), age 41–60 years (AOR 0.10, p < 0.001), traumatic intracranial hemorrhage (TICH) (AOR 0·11, p < 0·001), and Glasgow Coma Scale (GCS) 9–12 (AOR 0.14, p 0.001). The risk of 90-day mortality was higher in male (AHR 1.81, p = 0·006), GCS 3–8 (AHR 35.52, p < 0·001) and GCS 9–12 (AHR 7.46, p < 0·01) and lower in age 21–40 years (AHR 0.46, p = 0.034). Conclusion: Incorporating RNSD with EAMT is a plausible alternative to EAMT with a significant decrease in EAMT and decreased 90-day mortality in patients with ICH compared with non-neurosurgical care with EAMT. Despite a 34% decrease in 90-day mortality after RNSD, patient characteristics such as disease severity, age, and sex still dictated patient outcomes.

Original languageEnglish
Pages (from-to)524-531
Number of pages8
JournalJournal of the Formosan Medical Association
Volume119
Issue number1P3
DOIs
StatePublished - Jan 2020

Keywords

  • Emergency air medical transport
  • Intracranial hemorrhage
  • Routine neurosurgical dispatch

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