The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less

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

doi:10.3109/10903127.2010.545473

The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less

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

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

61 Scopus citations

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. Key words: prehospital intubation; traumatic brain injury; airway management; paramedic; outcomes; major trauma victim; ventilation; mortality; Glasgow Coma Scale score

Original language	English (US)
Pages (from-to)	184-192
Number of pages	9
Journal	Prehospital Emergency Care
Volume	15
Issue number	2
DOIs	https://doi.org/10.3109/10903127.2010.545473
State	Published - Apr 2011

Funding

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.

Funders	Funder number
National Institute of Health National Heart, Lung, and Blood Institute	U01HL077867
National Institute of Neurological Disorders and Stroke
American Heart Association/American Stroke Association
U.S. Army
Canadian Institutes of Health Research
Institute of Circulatory and Respiratory Health
Heart and Stroke Foundation Canada
Defence Research and Development Canada

Keywords

Glasgow Coma Scale score
airway management
major trauma victim
mortality
outcomes
paramedic
prehospital intubation
traumatic brain injury
ventilation

ASJC Scopus subject areas

Emergency Medicine
Emergency

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10.3109/10903127.2010.545473

Cite this

Davis, D. P., Koprowicz, K. M., Newgard, C. D., Daya, M., Bulger, E. M., Stiell, I., Nichol, G., Stephens, S., Dreyer, J., Minei, J., & Kerby, J. D. (2011). The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less. Prehospital Emergency Care, 15(2), 184-192. https://doi.org/10.3109/10903127.2010.545473

Davis, DP, Koprowicz, KM, Newgard, CD , Daya, M, Bulger, EM, Stiell, I, Nichol, G, Stephens, S, Dreyer, J, Minei, J & Kerby, JD 2011, 'The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less', Prehospital Emergency Care, vol. 15, no. 2, pp. 184-192. https://doi.org/10.3109/10903127.2010.545473

@article{b88f0fc9710f426c84c00e8c1a64b176,

title = "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. Key words: prehospital intubation; traumatic brain injury; airway management; paramedic; outcomes; major trauma victim; ventilation; mortality; Glasgow Coma Scale score",

keywords = "Glasgow Coma Scale score, airway management, major trauma victim, mortality, outcomes, paramedic, prehospital intubation, traumatic brain injury, ventilation",

author = "Davis, \{Daniel P.\} and Koprowicz, \{Kent M.\} and Newgard, \{Craig D.\} and Mohamud Daya and Bulger, \{Eileen M.\} and Ian Stiell and Graham Nichol and Shannon Stephens and Jonathan Dreyer and Joseph Minei and Kerby, \{Jeffrey D.\}",

note = "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){\textendash}Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, and the American Heart Association.",

year = "2011",

month = apr,

doi = "10.3109/10903127.2010.545473",

language = "English (US)",

volume = "15",

pages = "184--192",

journal = "Prehospital Emergency Care",

issn = "1090-3127",

publisher = "Taylor and Francis Ltd.",

number = "2",

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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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The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less

Abstract

Funding

Keywords

ASJC Scopus subject areas

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