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A tale of two cities: prehospital intubation with or without paralysing agents for traumatic brain injury
Author(s) -
Bendinelli Cino,
Ku Dominic,
Nebauer Shane,
King Kate L.,
Howard Teresa,
Gruen Russel,
Evans Tiffany,
Fitzgerald Mark,
Balogh Zsolt J.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14479
Subject(s) - medicine , glasgow coma scale , intubation , logistic regression , odds ratio , univariate analysis , emergency medicine , demographics , intensive care unit , injury severity score , head injury , abbreviated injury scale , anesthesia , retrospective cohort study , traumatic brain injury , poison control , injury prevention , surgery , demography , multivariate analysis , psychiatry , sociology
Background The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality. Methods Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay. Results One hundred and ninety‐two Victorian and 91 NSW patients did not differ in: demographics (males: 77% versus 79%; P = 0.7 and age: 34 (18–88) versus 33 (18–85); P = 0.7), Glasgow Coma Scale (3 (3–8) versus 5 (3–8); P = 0.07), and injury severity score (38 (26–75) versus 35 (18–75); P = 0.09), prehospital hypotension (15.4% versus 11.7%; P = 0.5) and desaturation (14.6% versus 17.5%; P = 0.5). Victorians had higher abbreviated injury scale head and neck (5 (4–5) versus 5 (3–6); P = 0.04) and more often successful PETI (85% versus 22%; P < 0.05). On logistic regression analysis, mortality did not differ among groups (31.7% versus 26.3%; P = 0.34; OR = 0.84; 95% CI: 0.38–1.86; P = 0.67). Among survivors, Victorians had longer stay in ICU (364 (231–486) versus 144 (60–336) h), a difference that persisted on gamma regression (effect = 1.58; 95% CI: 1.30–1.92; P < 0.05). Conclusion Paramedics using RSI to obtain PETI in patients with traumatic brain injury had a higher success rate. This increase in successful PETI rate was not associated with an improvement in either mortality rate or ICU length of stay.