TY - JOUR
T1 - The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less
AU - Davis, Daniel P.
AU - Koprowicz, Kent M.
AU - Newgard, Craig D.
AU - Daya, Mohamud
AU - Bulger, Eileen M.
AU - Stiell, Ian
AU - Nichol, Graham
AU - Stephens, Shannon
AU - Dreyer, Jonathan
AU - Minei, Joseph
AU - Kerby, Jeffrey D.
N1 - Funding Information:
The Resuscitation Outcomes Consortium (ROC) was supported by a series of cooperative agreements to 10 regional clinical centers and one data coordinating center (5U01 HL077863, HL077881, HL077871, HL077872, HL077866, HL077908, HL077867, HL077885, HL077877, HL077873) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research & Material Command, The Canadian Institutes of Health Research (CIHR)–Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association.
PY - 2011/4
Y1 - 2011/4
N2 - 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. Key words: prehospital intubation; traumatic brain injury; airway management; paramedic; outcomes; major trauma victim; ventilation; mortality; Glasgow Coma Scale score
AB - 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. Key words: prehospital intubation; traumatic brain injury; airway management; paramedic; outcomes; major trauma victim; ventilation; mortality; Glasgow Coma Scale score
KW - Glasgow Coma Scale score
KW - airway management
KW - major trauma victim
KW - mortality
KW - outcomes
KW - paramedic
KW - prehospital intubation
KW - traumatic brain injury
KW - ventilation
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U2 - 10.3109/10903127.2010.545473
DO - 10.3109/10903127.2010.545473
M3 - Article
C2 - 21309705
AN - SCOPUS:79952272516
SN - 1090-3127
VL - 15
SP - 184
EP - 192
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 2
ER -