Massachusetts Chapter of the American College of Surgeons

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Increasing Distance to Trauma Centers is Associated with Increased Mortality and Injury Severity in Aircraft Accidents
Francesca Izzo, MD, Kristina Z Kramer, MD, Gabriel Ryb, MD, Eleanor Winston, MD, Danielle Carroll, MD, Adin Tyler Putnam II, MD, Edward Kelly, MD, Tovy Haber Kamine, MD
Department of Surgery, Baystate Medical Center, Springfield, MA

Background:
Major trauma is a time-sensitive injury, with successful management requiring the diagnosis and management of primary injury as well as the prevention of secondary injuries from hypoxia or hypoperfusion. We sought to determine if the distance from trauma centers affects mortality in aircraft accidents.

Methods:
The National Transportation Safety Board (NTSB) database was queried for all aircraft accidents with substantial damage in the United States between 01/01/2018 and 12/31/2018. For accidents that resulted in injuries or fatalities, the drivable distance to the nearest level 3 or higher trauma center (level 3+ TC) was determined. A post-hoc Tukey-Kramer analysis was performed to determine differences between the distances to each level of trauma center.

Results:
550 accident reports were inspected with 382 injuries and fatalities (250 minor, 82 serious, 50 fatalities). The average (95% CI) distance to nearest level 3+ TC for fatalities was 31.8 (24.8-38.8) miles and for nonfatal injuries 18.8 (16.8-20.8) miles, p = <0.001. The average (95% CI) distance to nearest level 2+ TC for fatalities was 36.5 (27.9-45.0) miles and for nonfatal injuries 24.1 (21.3-26.8) miles, p = 0.002. The average (95% CI) distance to nearest level 1 TC for fatalities was 52.3 (40.8-63.8) miles and for nonfatal injuries 31.9 (28.0-35.8), p=<0.001. Post-hoc Tukey Kramer analysis demonstrates that fatalities were significantly farther from Level 1 TC when compared to Level 2 or 3 TC.

Conclusion:
Similar to data in motor vehicle collisions, aircraft accident fatalities are associated with a farther distance from a trauma center than non-fatal injuries.


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