ANZ Journal of Surgery, May 2018, Vol.88(5), pp.455-459
To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/ans.14479/abstract Byline: Cino Bendinelli, Dominic Ku, Shane Nebauer, Kate L. King, Teresa Howard, Russel Gruen, Tiffany Evans, Mark Fitzgerald,Zsolt J. Balogh Keywords: intubation; prehospital; traumatic brain injury 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 Scale2) 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. Article Note: C. Bendinelli MD, FRACS; D. Ku MD; S. Nebauer MD, MT; K. L. King RN, MN; T. Howard MD, PhD; R. Gruen MD, PhD, FRACS; T. Evans MMedStat; M. Fitzgerald MBBS, MD, FACEM, AFRACMA; Z. J. Balogh MD, PhD, FRACS. CAPTION(S): Table S1. Corrected mortality odds ratio for Victorian and NSW cohorts of patients with first prehospital GCS below or equal to five and AIS H/N higher or equal to three. Table S2. Corrected mortality odds ratio for Victorian and NSW cohorts of patients with prehospital GCS between six (included) and eight (included) and AIS H/N higher or equal to three. Table S3. Corrected comparison of the length of ICU stay among patients with prehospital GCS below nine and AIS H/N higher or equal to three from the Victorian and NSW cohorts, who were discharged alive.
Intubation ; Prehospital ; Traumatic Brain Injury