Distance impacts mortality in trauma patients with an intubation attempt

Michael T. Cudnik, Craig Newgard, Henry Wang, Christopher Bangs, Robert Herrington IV

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective. Out-of-hospital endotracheal intubation (OOH-ETI) has been associated with adverse outcomes; whether transport distance changes this relationship is unclear. We sought to determine whether patients injured farther from the hospital benefit more from OOH-ETI than those injured closer. Methods. We performed a retrospective cohort analysis of trauma patients > 14 years old transported to two Level 1 trauma centers and surviving to admission from 2000 to 2003. We used probabilistically linked geographic data to calculate transport distance. To adjust for the nonrandom selection of patients for OOH-ETI, we used a propensity score based on clinical variables: prehospital physiology, demographics, transport mode, mechanism, comorbidities, Abbreviated Injury Scale head injury score ≥ 3, Injury Severity Score, blood transfusion, and major surgery. Propensity-adjusted multivariable logistic regression with mode of transport was used to test the interaction between distance and OOH-ETI. Results. 8,786 patients were included, 534 with OOH-ETI. Patients with OOH-ETI had higher adjusted mortality (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.33-3.18), and there was a significant interaction between distance and OOH-ETI (p = 0.02). Patients with shortest distances had the highest mortality (OR 3.98, 95% CI 2.08-7.60). Probability of mortality was higher with OOH-ETI across all distances and increased for patients closest to the hospital. Helicopter transport was associated with improved survival. Conclusions. Prehospital intubation is associated with increased mortality among trauma patients at all distances from the hospital. Patients with the shortest transport distances had the greatest mortality associated with OOH-ETI, whereas helicopter transport was associated with improved survival. The event location and ensuing distance to the hospital are another factor to consider when instituting and modifying OOH airway protocols.

Original languageEnglish (US)
Pages (from-to)459-466
Number of pages8
JournalPrehospital Emergency Care
Volume12
Issue number4
DOIs
StatePublished - Sep 2008

Fingerprint

Intubation
Intratracheal Intubation
Mortality
Wounds and Injuries
Aircraft
Odds Ratio
Abbreviated Injury Scale
Confidence Intervals
Propensity Score
Injury Severity Score
Survival
Trauma Centers
Craniocerebral Trauma
Blood Transfusion
Patient Selection
Comorbidity
Cohort Studies
Logistic Models
Demography

Keywords

  • Adult
  • Distance
  • Emergency medical services
  • Intubation
  • Outcome
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Distance impacts mortality in trauma patients with an intubation attempt. / Cudnik, Michael T.; Newgard, Craig; Wang, Henry; Bangs, Christopher; Herrington IV, Robert.

In: Prehospital Emergency Care, Vol. 12, No. 4, 09.2008, p. 459-466.

Research output: Contribution to journalArticle

Cudnik, Michael T. ; Newgard, Craig ; Wang, Henry ; Bangs, Christopher ; Herrington IV, Robert. / Distance impacts mortality in trauma patients with an intubation attempt. In: Prehospital Emergency Care. 2008 ; Vol. 12, No. 4. pp. 459-466.
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abstract = "Objective. Out-of-hospital endotracheal intubation (OOH-ETI) has been associated with adverse outcomes; whether transport distance changes this relationship is unclear. We sought to determine whether patients injured farther from the hospital benefit more from OOH-ETI than those injured closer. Methods. We performed a retrospective cohort analysis of trauma patients > 14 years old transported to two Level 1 trauma centers and surviving to admission from 2000 to 2003. We used probabilistically linked geographic data to calculate transport distance. To adjust for the nonrandom selection of patients for OOH-ETI, we used a propensity score based on clinical variables: prehospital physiology, demographics, transport mode, mechanism, comorbidities, Abbreviated Injury Scale head injury score ≥ 3, Injury Severity Score, blood transfusion, and major surgery. Propensity-adjusted multivariable logistic regression with mode of transport was used to test the interaction between distance and OOH-ETI. Results. 8,786 patients were included, 534 with OOH-ETI. Patients with OOH-ETI had higher adjusted mortality (odds ratio [OR] 2.06, 95{\%} confidence interval [CI] 1.33-3.18), and there was a significant interaction between distance and OOH-ETI (p = 0.02). Patients with shortest distances had the highest mortality (OR 3.98, 95{\%} CI 2.08-7.60). Probability of mortality was higher with OOH-ETI across all distances and increased for patients closest to the hospital. Helicopter transport was associated with improved survival. Conclusions. Prehospital intubation is associated with increased mortality among trauma patients at all distances from the hospital. Patients with the shortest transport distances had the greatest mortality associated with OOH-ETI, whereas helicopter transport was associated with improved survival. The event location and ensuing distance to the hospital are another factor to consider when instituting and modifying OOH airway protocols.",
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