The Effects of Transport Altitude on Outcomes in Traumatic Brain Injury (HEIGHT-TBI): An Observational Cohort Study.
Transport above 6000 ft linked to higher in-hospital mortality after traumatic brain injury
The Effects of Transport Altitude on Outcomes in Traumatic Brain Injury (HEIGHT-TBI): An Observational Cohort Study.
Traumatic brain injury (traumatic brain injury) that is more than minor frequently requires aeromedical transport to higher-level trauma centers.
This study aimed to evaluate whether transport altitude is associated with in-hospital mortality in adults with more than minor traumatic brain injury.
We performed a retrospective cohort study of adult patients (≥ 18 years) with more than minor traumatic brain injury (Abbreviated Injury Scale-Head [AIS Head] score > 1) transported by air between January 2017 and December 2023.
flying above 6000 feet linked to far higher odds of death
The cohort included 1135 flights involving 1132 individual patients (mean age 53.6 years; 69.6% male).
In-air hypotension was independently linked to increased mortality (aOR 4.26, 95% CI 2.22-8.19) and discharge to a care facility (aOR 3.45, 95% CI 2.03-5.87).
Longer transport times were paradoxically associated with a slight reduction in mortality (aOR 0.97, 95% CI 0.95-0.99).
Transport altitude did not significantly affect hospital or intensive care unit LOS.
Transport above 6000 ft and in-flight hypotension are associated with increased in-hospital mortality among patients with more than minor traumatic brain injury.
These findings underscore the need for further research on the physiological impact of hypobaric aeromedical transport and the development of mitigation strategies to optimize patient outcomes.