Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation ()
Affiliation(s)
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.
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.
Share and Cite:
J. Tallon, G. Flowerdew, R. Stewart and G. Kovacs, "Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation,"
International Journal of Clinical Medicine, Vol. 4 No. 2, 2013, pp. 78-85. doi:
10.4236/ijcm.2013.42015.