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*HEAD INJURY AND OUTCOME – WHAT INFLUENCE DOES PREHOSPITAL INTUBATION HAVE?
Author(s) -
Bendinelli C.,
Nebauer S.,
Evans J.,
Balogh Z.
Publication year - 2009
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/j.1445-2197.2009.04934_6.x
Subject(s) - medicine , glasgow coma scale , abbreviated injury scale , intubation , injury severity score , emergency medicine , head injury , retrospective cohort study , major trauma , univariate analysis , trauma centre , mortality rate , traumatic brain injury , poison control , anesthesia , injury prevention , surgery , multivariate analysis , psychiatry
Mortality of severe traumatic brain injury (STBI) varies in literature between 23 and 81% depending on pre‐hospital use of neuromuscular blocking agents (NBA) for endotracheal intubation (ETI) (1, 2). In NSW paramedics are not equipped with NBA. Aim of this study was to determine mortality of STBI patients in a NSW Trauma Centre and compare to intentional standards as an initial step to evaluate potential applicability of NBA for ETI in NSW. Methods: A four‐year retrospective study ending December 2008 on consecutive trauma patients admitted to a NSW Level‐1 Trauma Centre with a pre‐hospital Glasgow Coma Score (GCS) < 9 and STBI [Abbreviated Injury Scale (AIS) > 2]. Patients were identified from trauma registry and focused chart review was performed. Primary outcome was mortality. Results are presented as mean ± SD or percentages. Statistical significance was determined at p < 0.05 based on univariate analysis. Results: A total of 124 patients were identified (age 36.4 ± 20, pre‐hospital GCS 4.8 ± 2, ISS 30.6 ± 13, head AIS 4.2 ± 0.7, 28% had systolic blood pressure (SBP) < 90 mmHg). The overall mortality was 34.6%. 27 patients had pre‐hospital ETI with 74.0% mortality. In 5 patients pre‐hospital ETT failed (mortality 20%). 92 patients had ETT on arrival to hospital (mortality 24.4%). Survivors differed from those who died (age <55: 91% vs 52%, ISS: 26.9 ± 10.7 vs 37 ± 16.3, AIS: 4.1 ± 0.6 vs 5.2 ± 2.0, GCS: 5.2 ± 2.0 vs 4.0 ± 1.7, and SBP < 90 mmHg: 15.8% vs 50%). ETI < 30 minutes from injury was more common among non‐survivors (2.7% vs 21.6%). Discussion: Mortality is comparable with trauma systems without pre‐hospital NBA. State‐wide assessment of the STBI outcomes is recommended to determine the potential applicability of pre‐hospital use of NBA.