The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less.

Abstract

BACKGROUND:

Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury.

OBJECTIVES:

To explore the relationship between out-of-hospital intubation attempts and outcome among trauma patients with Glasgow Coma Scale (GCS) scores ≤ 8 across sites participating in the Resuscitation Outcomes Consortium (ROC).

METHODS:

The ROC Epistry-Trauma, an epidemiologic database of prehospital encounters with critically injured trauma victims, was used to identify emergency medical services (EMS)-treated patients with GCS scores ≤ 8. Multiple logistic regression was used to explore the association between intubation attempts and vital status at discharge, adjusting for the following covariates: age, gender, GCS score, hypotension, mechanism of injury, and ROC site. Sites were then stratified by frequency of intubation attempts and chi-square test for trend was used to associate the frequency of intubation attempts with outcome.

RESULTS:

A total of 1,555 patients were included in this analysis; intubation was attempted in 758 of these. Patients in whom intubation was attempted had higher mortality (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 2.13-3.98, p < 0.01). However, sites with higher rates of attempted intubation had lower mortality across all trauma victims with GCS scores ≤ 8 (OR 1.40, 95% CI 1.15-1.72, p < 0.01).

CONCLUSIONS:

Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ≤ 8. Coma Scale score.

• Authors: Daniel P Davis, Kent M Koprowicz, Craig D Newgard, Mohamud Daya, Eileen M Bulger, Ian Stiell, Graham Nichol, Shannon Stephens, Jonathan Dreyer, Joseph Minei, Jeffrey D Kerby
• Journal: Prehospital emergency care (Prehosp Emerg Care) 2011 Apr-Jun Vol. 15 Issue 2 Pg. 184-92 ISSN: 1545-0066 [Electronic] England
• PMID: 21309705 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Adult
• Airway Management (methods)
• Brain Injuries (mortality, therapy)
• Emergency Medical Services (methods)
• Female
• Glasgow Coma Scale
• Humans
• Injury Severity Score
• Logistic Models
• Male
• Prognosis
• Registries
• Risk Assessment
• Treatment Outcome
• United States