Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation — Oak Academic Publishing
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Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation
Departments of Emergency Medicine and Surgery, Capital Health, Dalhousie University, Halifax, Canada
,
Department of Commu- nity Health and Epidemiology, Dalhousie University, Halifax, Canada
,
Faculties of Medicine and Health Professions, Dalhousie University, Halifax, Canada
,
Department of Emergency Medicine, Dalhousie University, Halifax, Canada
1 Departments of Emergency Medicine and Surgery, Capital Health, Dalhousie University, Halifax, Canada
2 Department of Commu- nity Health and Epidemiology, Dalhousie University, Halifax, Canada
3 Faculties of Medicine and Health Professions, Dalhousie University, Halifax, Canada
4 Department of Emergency Medicine, Dalhousie University, Halifax, Canada
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.
KeywordsTraumaHead InjuryTracheal IntubationMortalityEmergency Medical ServicesEmergency Medicine
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