Distance Impacts Mortality in Trauma Patients with an Intubation Attempt

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 andsurviving 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, andmajor surgery. Propensity-adjusted multivariable logistic regression with mode of transport was used to test the interaction between distance andOOH-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), andthere was a significant interaction between distance andOOH-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 andincreased 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 andensuing distance to the hospital are another factor to consider when instituting andmodifying OOH airway protocols.

Key words:

• emergency medical services
• trauma
• adult
• intubation
• outcome
• distance