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Prehospital Emergency Care Volume 15, 2011 - Issue 2
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Focus on Trauma

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 From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.Correspondence[email protected]
, MD,
Kent M. Koprowicz From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MS,
Craig D. Newgard From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD, MPH,
Mohamud Daya From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD, MS,
Eileen M. Bulger From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD,
Ian Stiell From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD,
Graham Nichol From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD,
Shannon Stephens From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, EMT-P,
Jonathan Dreyer From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD,
Joseph Minei From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
, MD &
Jeffrey D. Kerby From the Department of Emergency Medicine (DPD), UCSD Center for Resuscitation Science, San Diego, California; the University of Washington (KMK), Seattle, Washington; Axio Research Corporation (KMK), Seattle, Washington; the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (CDN, MD), Oregon Health & Science University, Portland, Oregon; the Department of Surgery (EMB), University of Washington, Seattle, Washington; the Department of Emergency Medicine (IS), University of Ottawa, Ottawa, Ontario, Canada; the Clinical Trials Center (GN), University of Washington, Seattle, Washington; the Department of Surgery (SS, JDK), University of Alabama at Birmingham, Birmingham, Alabama; the Division of Emergency Medicine (JD), University of Western Ontario, London, Ontario, Canada; and Parkland Memorial Hospital (JM), University of Texas Southwestern Medical Center, Dallas, Texas.
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Pages 184-192 | Received 18 Feb 2010, Accepted 16 Nov 2010, Published online: 10 Feb 2011
 
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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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