European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
Prehospital severity and in-hospital mortality in trauma patients managed by the Friuli-Venezia Giulia helicopter emergency medical service: a 6-year retrospective cohort study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Tomasino Serena, Pegani Carlo, Orso Daniele, Ursella Cristian, Tullio Annarita, Bacchetti Giacomo, Molinari Chiara, Marangone Anna, Contadini Michele, Durì Davide, Saffer Samantha, Fantin Sabrina, Sappada Alessio, Peratoner Alberto, Trillò Giulio, Roncarati Andrea, Bove Tiziana, Spasiano Alessandra, Della Rocca Giorgio
Аннотация
BACKGROUND: Data on in-hospital mortality among trauma patients managed by Helicopter Emergency Medical Services (HEMS) in Italy remain limited. We aimed to describe the epidemiology and in-hospital mortality of trauma patients transported after management by the Friuli-Venezia Giulia HEMS and to assess prehospital factors associated with death.
METHODS: We conducted a retrospective observational cohort study including trauma patients managed by HEMS FVG and transported to hospital, either directly by HEMS or after continuation of transport by ground emergency medical services, between 2018 and 2023. The primary outcome was in-hospital mortality. Jeffreys-prior penalized logistic regression was used to reduce sparse-data bias and instability from separation. The RTS-based model was designated as the primary model and the NACA-based model as a secondary sensitivity analysis. Model performance was assessed internally, and the functional forms of both age and RTS were examined using restricted cubic splines.
RESULTS: Of 3,357 trauma records in the source cohort, 205 prehospital deaths were excluded from the in-hospital mortality analysis, leaving 3,152 transported patients. Outcome data were available for 3,143 patients, of whom 107 died in hospital (3.4%). In the primary RTS-based model, older age, lower RTS, tracheal intubation, and prehospital CPR were associated with mortality. Compared with RTS ≥ 7, adjusted ORs were 2.36 (95% CI 1.11-5.50) for RTS 4-<7 and 5.19 (95% CI 1.64-17.04) for RTS < 4. Age was associated with mortality (OR 1.03 per year, 95% CI 1.01-1.04). Continuous RTS analysis was concordant (OR 0.68 per one-point increase, 95% CI 0.54-0.86; p = 0.0013).
CONCLUSIONS: Among trauma patients transported to hospital after HEMS management, older age, higher prehospital injury severity, tracheal intubation, and prehospital CPR were associated with in-hospital mortality. Intubation and CPR should be interpreted primarily as markers of severe physiological compromise rather than causal determinants of death.
METHODS: We conducted a retrospective observational cohort study including trauma patients managed by HEMS FVG and transported to hospital, either directly by HEMS or after continuation of transport by ground emergency medical services, between 2018 and 2023. The primary outcome was in-hospital mortality. Jeffreys-prior penalized logistic regression was used to reduce sparse-data bias and instability from separation. The RTS-based model was designated as the primary model and the NACA-based model as a secondary sensitivity analysis. Model performance was assessed internally, and the functional forms of both age and RTS were examined using restricted cubic splines.
RESULTS: Of 3,357 trauma records in the source cohort, 205 prehospital deaths were excluded from the in-hospital mortality analysis, leaving 3,152 transported patients. Outcome data were available for 3,143 patients, of whom 107 died in hospital (3.4%). In the primary RTS-based model, older age, lower RTS, tracheal intubation, and prehospital CPR were associated with mortality. Compared with RTS ≥ 7, adjusted ORs were 2.36 (95% CI 1.11-5.50) for RTS 4-<7 and 5.19 (95% CI 1.64-17.04) for RTS < 4. Age was associated with mortality (OR 1.03 per year, 95% CI 1.01-1.04). Continuous RTS analysis was concordant (OR 0.68 per one-point increase, 95% CI 0.54-0.86; p = 0.0013).
CONCLUSIONS: Among trauma patients transported to hospital after HEMS management, older age, higher prehospital injury severity, tracheal intubation, and prehospital CPR were associated with in-hospital mortality. Intubation and CPR should be interpreted primarily as markers of severe physiological compromise rather than causal determinants of death.