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

Research output: Contribution to journalArticle

34 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 languageEnglish (US)
Pages (from-to)184-192
Number of pages9
JournalPrehospital Emergency Care
Volume15
Issue number2
DOIs
StatePublished - Apr 1 2011

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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