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.
Highlights
Injury remains the leading cause of death in Canada for those under age 45 years and the largest contributor to potential life years lost of any single disease process in Canada under the age of 70 years [1]
Conventional unconditional logistic regression modelled on mortality with “pre-hospital intubation (PHI) vs. emergency department intubation (EDI)” as the intervention of interest showed an odds ratio of 2.015 for improved survival if these patients were intubated in the emergency department rather than in the pre-hospital phase of care
Unadjusted mortality in the EDI cohort was 24.9%, and in the PHI cohort was 50%. These numbers are quite similar to those found by Wang [25], who demonstrated an overall unadjusted mortality of 37.1%, with higher mortality in the PHI cohort (48.5%) vs. his EDI cohort (28.2%)
Summary
Injury remains the leading cause of death in Canada for those under age 45 years and the largest contributor to potential life years lost of any single disease process in Canada under the age of 70 years [1]. This study measured the effect on mortality of pre-hospital intubation (PHI) vs emergency department intubation (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. 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. 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
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