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 Newgard, Mohamud Ramzan Daya, Eileen M. Bulger, Ian Stiell, Graham Nichol, Shannon Stephens, Jonathan Dreyer, Joseph Minei, Jeffrey D. Kerby

Research output: Contribution to journalArticle

33 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)184-192
Number of pages9
JournalPrehospital Emergency Care
Volume15
Issue number2
DOIs
StatePublished - Apr 2011

Fingerprint

Glasgow Coma Scale
Airway Management
Intubation
Wounds and Injuries
Mortality
Resuscitation
Odds Ratio
Confidence Intervals
Allied Health Personnel
Intratracheal Intubation
Emergency Medical Services
Chi-Square Distribution
Hypotension
Ventilation
Logistic Models
Databases

Keywords

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

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Medicine(all)

Cite this

The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less. / Davis, Daniel P.; Koprowicz, Kent M.; Newgard, Craig; Daya, Mohamud Ramzan; Bulger, Eileen M.; Stiell, Ian; Nichol, Graham; Stephens, Shannon; Dreyer, Jonathan; Minei, Joseph; Kerby, Jeffrey D.

In: Prehospital Emergency Care, Vol. 15, No. 2, 04.2011, p. 184-192.

Research output: Contribution to journalArticle

Davis, Daniel P. ; Koprowicz, Kent M. ; Newgard, Craig ; Daya, Mohamud Ramzan ; Bulger, Eileen M. ; Stiell, Ian ; Nichol, Graham ; Stephens, Shannon ; Dreyer, Jonathan ; Minei, Joseph ; Kerby, Jeffrey D. / The relationship between out-of-hospital airway management and outcome among trauma patients with glasgow coma scale scores of 8 or less. In: Prehospital Emergency Care. 2011 ; Vol. 15, No. 2. pp. 184-192.
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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",
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AU - Bulger, Eileen M.

AU - Stiell, Ian

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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

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