Quality of life following trauma before and after implementation of a physician-staffed helicopter

Abstract

Background: Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients.

Methods: Prospective, observational study including trauma patients who survived at least 3 years after injury. A 5-month period prior to PS-HEMS implementation was compared with the first 12 months after PS-HEMS implementation. QoL was assessed 4.5 years after trauma by the SF-36 questionnaire. Primary endpoint was the Physical Component Summary score.

Results: Of the 1994 patients assessed by a trauma team, 1521 were eligible for inclusion in the study. Of these, 566 (37%) gave consent to participate and received a questionnaire by mail, and 402 (71%) of them returned the questionnaire (n = 114 before PS-HEMS; n = 288 after PS-HEMS implementation). Older patients, women and patients with trauma in the after PS-HEMS period were more likely to return the questionnaire. No significant association between QoL and period (before vs. after PS-HEMS) was found; the Physical Component Summary scores were 50.0 and 50.9 in the before and after PS-HEMS periods, respectively (P = 0.47). We also found no difference on multivariable analysis with adjustment for sex, age and injury severity score.

Conclusion: No significant difference in QoL among trauma patients was found after implementation of a PS-HEMS.

Figure 1

Flowchart of included patients. PS‐HEMS: Physician‐staffed helicopter emergency medical service.

Figure 2

Comparisons of SF‐36 scores between trauma patients before and after implementation of a helicopter emergency medical service. Pre‐HEMS: before implementation of a physician‐staffed helicopter emergency medical service; post‐HEMS: after implementation of a physician‐staffed helicopter emergency medical service; RE: Role Emotional; MH: Mental Health; SF: Social Functioning; VT: Vitality; BP: Bodily Pain; RP: Role Physical; PF: Physical Functioning, GH: General Health; PCS: Physical Component Summary; MCS: Mental Component Summary; line in box: median score; box: interquartile range; whiskers: 5–95 percentiles; circles: outliers (observations beyond the value of 5–95 percentiles).