Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation

John M. Tallon, Gordon Flowerdew, Ronald D. Stewart, George Kovacs

Department of Commu- nity Health and Epidemiology, Dalhousie University, Halifax, Canada.
Department of Emergency Medicine, Dalhousie University, Halifax, Canada.
Departments of Emergency Medicine and Surgery, Capital Health, Dalhousie University, Halifax, Canada.
Faculties of Medicine and Health Professions, Dalhousie University, Halifax, Canada.

DOI: 10.4236/ijcm.2013.42015                

Abstract

Background: The optimal treatment of major head injuries in the resuscitative phase of care post-injury has yet to be determined. This study measured the effect on mortality of pre-hospital intubation (PHI) vs. emergency department in tubation (EDI) of patients suffering serious head injury. Methods: In the single emergency medical services system for this Canadian province, we used a population-based trauma database, conventional logistic regression (with and without the use of a propensity score to control for selection effect bias) to evaluate the effect of PHI vs. EDI on in-hospital mortality. Inclusion criteria were age ≥ 16 years, serious head injury (Abbreviated Injury Score ≥ 3, non-penetrating trauma) and resuscitative intubation (PHI or EDI). Results: Over 5 years, 283 patients (2000-2005) met inclusion crite ria. Conventional unconditional logistic regression modelled on mortality with “PHI vs. EDI” as the intervention of interest showed an odds ratio of 2.015 (95% CI 1.062 3.825) for improved survival if these patients were intubated in the emergency department rather than in the pre-hospital phase of care. A propensity score adjustment demonstrated a similar but more conservative point estimate (OR 1.727, 95% CI: 0.993 3.004). Conclusions: This observational study demonstrated a survival advantage with EDI (versus PHI) in seriously head-injured patients in a mature, province-wide emergency medical services system.

Keywords

Trauma; Head Injury; Tracheal Intubation; Mortality; Emergency Medical Services; Emergency Medicine

Conflicts of Interest

The authors declare no conflicts of interest.

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