Endotracheal intubation increases out-of-hospital time in trauma patients

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

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives. Prior efforts have linked field endotracheal intubation (ETI) with increased out of hospital (OOH) time, but it is not clear if the additional time delay is due to the procedure, patient acuity, or transport distance. We sought to assess the difference in OOH time among trauma patients with and without OOH-ETI after accounting for distance and other clinical variables. Methods. Retrospective cohort analysis of trauma patients 14 years or older transported by ground or air to one of two Level 1 trauma centers from January 2000 to December 2003. Geographical data were probabilistically linked to trauma registry records for transport distance. Trauma registry OOH time (interval from 9-1-1 call to hospital arrival) was validated against a subset of linked ambulance records using Bland-Altman plots and tested by using the Spearman rank correlation coefficient. Based on the validation, the sample was restricted to patients with OOH time 100 minutes or less. The propensity for OOH-ETI was calculated by using field vital signs, demographics, mechanism, transport mode, comorbidities, Abbreviated Injury Scale head injury 3 or greater, injury severity score, blood transfusion, and major surgery. Multivariable linear regression (outcome = total OOH time) was used to assess the time increase (minutes) associated with OOH-ETI after adjusting for distance, propensity for OOH-ETI, and mode of transport. Results. A total of 8,707 patients were included in the analysis, of which 570 (6.5%) were intubated in the field. Adjusted only for distance, OOH times averaged 6.1 minutes longer (95% CI 4.2-7.9) among patients intubated with RSI. After including other covariates, OOH time was 10.7 minutes (95% CI 7.7-13.8) longer among patients with RSI and 5.2 minutes (95% CI 2.2-8.1) longer among patients with conventional ETI. The time difference was greatest farther from the hospital. Conclusions. Patients with OOH-ETI have increased total OOH time, especially among those using RSI, even after accounting for distance and other clinical factors. Injured patients may benefit from airway management techniques that require less time for execution.

Original languageEnglish (US)
Pages (from-to)224-229
Number of pages6
JournalPrehospital Emergency Care
Volume11
Issue number2
DOIs
StatePublished - Apr 2007

Fingerprint

Intratracheal Intubation
Wounds and Injuries
Registries
Abbreviated Injury Scale
Patient Acuity
Injury Severity Score
Airway Management
Ambulances
Vital Signs
Trauma Centers
Nonparametric Statistics
Craniocerebral Trauma
Blood Transfusion

Keywords

  • Adults
  • Emergency medical services
  • Intubation
  • Time
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Endotracheal intubation increases out-of-hospital time in trauma patients. / Cudnik, Michael T.; Newgard, Craig; Wang, Henry; Bangs, Christopher; Herringtion IV, Robert.

In: Prehospital Emergency Care, Vol. 11, No. 2, 04.2007, p. 224-229.

Research output: Contribution to journalArticle

Cudnik, Michael T. ; Newgard, Craig ; Wang, Henry ; Bangs, Christopher ; Herringtion IV, Robert. / Endotracheal intubation increases out-of-hospital time in trauma patients. In: Prehospital Emergency Care. 2007 ; Vol. 11, No. 2. pp. 224-229.
@article{d63faa253d894187afbb8eae33c73bd8,
title = "Endotracheal intubation increases out-of-hospital time in trauma patients",
abstract = "Objectives. Prior efforts have linked field endotracheal intubation (ETI) with increased out of hospital (OOH) time, but it is not clear if the additional time delay is due to the procedure, patient acuity, or transport distance. We sought to assess the difference in OOH time among trauma patients with and without OOH-ETI after accounting for distance and other clinical variables. Methods. Retrospective cohort analysis of trauma patients 14 years or older transported by ground or air to one of two Level 1 trauma centers from January 2000 to December 2003. Geographical data were probabilistically linked to trauma registry records for transport distance. Trauma registry OOH time (interval from 9-1-1 call to hospital arrival) was validated against a subset of linked ambulance records using Bland-Altman plots and tested by using the Spearman rank correlation coefficient. Based on the validation, the sample was restricted to patients with OOH time 100 minutes or less. The propensity for OOH-ETI was calculated by using field vital signs, demographics, mechanism, transport mode, comorbidities, Abbreviated Injury Scale head injury 3 or greater, injury severity score, blood transfusion, and major surgery. Multivariable linear regression (outcome = total OOH time) was used to assess the time increase (minutes) associated with OOH-ETI after adjusting for distance, propensity for OOH-ETI, and mode of transport. Results. A total of 8,707 patients were included in the analysis, of which 570 (6.5{\%}) were intubated in the field. Adjusted only for distance, OOH times averaged 6.1 minutes longer (95{\%} CI 4.2-7.9) among patients intubated with RSI. After including other covariates, OOH time was 10.7 minutes (95{\%} CI 7.7-13.8) longer among patients with RSI and 5.2 minutes (95{\%} CI 2.2-8.1) longer among patients with conventional ETI. The time difference was greatest farther from the hospital. Conclusions. Patients with OOH-ETI have increased total OOH time, especially among those using RSI, even after accounting for distance and other clinical factors. Injured patients may benefit from airway management techniques that require less time for execution.",
keywords = "Adults, Emergency medical services, Intubation, Time, Trauma",
author = "Cudnik, {Michael T.} and Craig Newgard and Henry Wang and Christopher Bangs and {Herringtion IV}, Robert",
year = "2007",
month = "4",
doi = "10.1080/10903120701205208",
language = "English (US)",
volume = "11",
pages = "224--229",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",
number = "2",

}

TY - JOUR

T1 - Endotracheal intubation increases out-of-hospital time in trauma patients

AU - Cudnik, Michael T.

AU - Newgard, Craig

AU - Wang, Henry

AU - Bangs, Christopher

AU - Herringtion IV, Robert

PY - 2007/4

Y1 - 2007/4

N2 - Objectives. Prior efforts have linked field endotracheal intubation (ETI) with increased out of hospital (OOH) time, but it is not clear if the additional time delay is due to the procedure, patient acuity, or transport distance. We sought to assess the difference in OOH time among trauma patients with and without OOH-ETI after accounting for distance and other clinical variables. Methods. Retrospective cohort analysis of trauma patients 14 years or older transported by ground or air to one of two Level 1 trauma centers from January 2000 to December 2003. Geographical data were probabilistically linked to trauma registry records for transport distance. Trauma registry OOH time (interval from 9-1-1 call to hospital arrival) was validated against a subset of linked ambulance records using Bland-Altman plots and tested by using the Spearman rank correlation coefficient. Based on the validation, the sample was restricted to patients with OOH time 100 minutes or less. The propensity for OOH-ETI was calculated by using field vital signs, demographics, mechanism, transport mode, comorbidities, Abbreviated Injury Scale head injury 3 or greater, injury severity score, blood transfusion, and major surgery. Multivariable linear regression (outcome = total OOH time) was used to assess the time increase (minutes) associated with OOH-ETI after adjusting for distance, propensity for OOH-ETI, and mode of transport. Results. A total of 8,707 patients were included in the analysis, of which 570 (6.5%) were intubated in the field. Adjusted only for distance, OOH times averaged 6.1 minutes longer (95% CI 4.2-7.9) among patients intubated with RSI. After including other covariates, OOH time was 10.7 minutes (95% CI 7.7-13.8) longer among patients with RSI and 5.2 minutes (95% CI 2.2-8.1) longer among patients with conventional ETI. The time difference was greatest farther from the hospital. Conclusions. Patients with OOH-ETI have increased total OOH time, especially among those using RSI, even after accounting for distance and other clinical factors. Injured patients may benefit from airway management techniques that require less time for execution.

AB - Objectives. Prior efforts have linked field endotracheal intubation (ETI) with increased out of hospital (OOH) time, but it is not clear if the additional time delay is due to the procedure, patient acuity, or transport distance. We sought to assess the difference in OOH time among trauma patients with and without OOH-ETI after accounting for distance and other clinical variables. Methods. Retrospective cohort analysis of trauma patients 14 years or older transported by ground or air to one of two Level 1 trauma centers from January 2000 to December 2003. Geographical data were probabilistically linked to trauma registry records for transport distance. Trauma registry OOH time (interval from 9-1-1 call to hospital arrival) was validated against a subset of linked ambulance records using Bland-Altman plots and tested by using the Spearman rank correlation coefficient. Based on the validation, the sample was restricted to patients with OOH time 100 minutes or less. The propensity for OOH-ETI was calculated by using field vital signs, demographics, mechanism, transport mode, comorbidities, Abbreviated Injury Scale head injury 3 or greater, injury severity score, blood transfusion, and major surgery. Multivariable linear regression (outcome = total OOH time) was used to assess the time increase (minutes) associated with OOH-ETI after adjusting for distance, propensity for OOH-ETI, and mode of transport. Results. A total of 8,707 patients were included in the analysis, of which 570 (6.5%) were intubated in the field. Adjusted only for distance, OOH times averaged 6.1 minutes longer (95% CI 4.2-7.9) among patients intubated with RSI. After including other covariates, OOH time was 10.7 minutes (95% CI 7.7-13.8) longer among patients with RSI and 5.2 minutes (95% CI 2.2-8.1) longer among patients with conventional ETI. The time difference was greatest farther from the hospital. Conclusions. Patients with OOH-ETI have increased total OOH time, especially among those using RSI, even after accounting for distance and other clinical factors. Injured patients may benefit from airway management techniques that require less time for execution.

KW - Adults

KW - Emergency medical services

KW - Intubation

KW - Time

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=34047167002&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34047167002&partnerID=8YFLogxK

U2 - 10.1080/10903120701205208

DO - 10.1080/10903120701205208

M3 - Article

VL - 11

SP - 224

EP - 229

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

IS - 2

ER -