Interfacility Helicopter Ambulance Transport of Neurosurgical Patients: Observations, Utilization, and Outcomes from a Quaternary Level Care Hospital

The clinical benefit of helicopter transport over ground transportation for interfacility transport is unproven. We sought to determine actual practice patterns, utilization, and outcomes of patients undergoing interfacility transport for neurosurgical conditions.We retrospectively examined all interfacility helicopter transfers to a single trauma center during 2008. We restricted our analysis to those transfers leading either to admission to the neurosurgical service or to formal consultation upon arrival. Major exclusion criteria included transport from the scene, death during transport, and transport to any area of the hospital other than the emergency department. The primary outcome was time interval to invasive intervention. Secondary outcomes were estimated ground transportation times from the referring hospital, admitting disposition, and discharge disposition. Of 526 candidate interfacility helicopter transfers to our emergency department in 2008, we identified 167 meeting study criteria. Seventy-five (45%) of these patients underwent neurosurgical intervention. The median time to neurosurgical intervention ranged from 1.0 to 117.8 hours, varying depending on the diagnosis. For 101 (60%) of the patients, estimated driving time from the referring institution was less than one hour. Four patients (2%) expired in the emergency department, and 34 patients (20%) were admitted to a non-ICU setting. Six patients were discharged home within 24 hours. For those admitted, in-hospital mortality was 28%.Many patients undergoing interfacility transfer for neurosurgical evaluation are inappropriately triaged to helicopter transport, as evidenced by actual times to intervention at the accepting institution and estimated ground transportation times from the referring institution. In a time when there is growing interest in health care cost containment, practitioners must exercise discretion in the selection of patients for air ambulance transport--particularly when it may not bear influence on clinical outcome. Neurosurgical evaluation via telemedicine may be one strategy for improving air transport triage

Nonruptured intracranial aneurysms: Therapeutic recommendations

With the development of new diagnostic noninvasive tools an increase in the diagnosis of asymptomatic nonruptured intracranial aneurysms has been shown. Physician and patient now have to decide wether to treat or to follow-up these aneurysms. This paper trys to review and to discuss the literature and to give guidelines for therapeutic decisions. The decision to treat an unruptured intracranial aeurysm must always comprise the individuell factors such as age, life prognosis, neurological status, and the advantages and disdavantages of the considered method

Thrombosis of cerebral veins and sinuses: Diagnostics and therapy

Thrombosis of the cerebral veins and sinuses is a rare but important cause of stroke. The clinical symptoms are variable which makes the correct diagnosis difficult. Magnetic resonance imaging (MRI) combined with MR angiography allows to diagnose occluded cerebral veins. The correct diagnosis can also be made by computed tomography (CT) and CT venography. To date, no standardized therapy exists. Normally, patients will receive full heparinization, and in very severe cases an attempt at thrombolysis may be made. In most patients, the prognosis is good, and the mortality rate usually amounts to < 10%. © Urban and Vogel