Abstract
BackgroundA surgical airway is usually unpredictable in trauma patients. The aim of this study was to develop a predictable scoring system to determine the need for a surgical airway by using a database from a large multicenter trauma registry.MethodsWe obtained data from the nationwide trauma registry in Japan for adult blunt trauma patients who were intubated in the emergency department. Based on a multivariate logistic regression analysis in the development cohort, the Quick Surgical Airway Assessment for Trauma (qSAT) score was defined to predict the need for a surgical airway. The association of the qSAT with surgical airway was validated in the validation cohort.ResultsBetween 2004 and 2014, 17,036 trauma patients were eligible. In the development phase (n = 8129), the qSAT score was defined as the sum of the three binary components, including male sex, presence of a facial injury, and presence of a cervical area injury, for a total score ranging from 0 to 3. In the validation cohort (n = 8907), the proportion of patients with a surgical airway markedly increased with increasing qSAT score (0 points, 0.5%; 1 point, 0.9%; 2 points, 3.5%; 3 points, 25.0%; P < 0.001). Multivariate analysis revealed that qSAT score was an independent predictor of surgical airway (adjusted OR, 3.19 per 1 point increase; 95% CI, 2.47–4.12; P < 0.0001). The qSAT score of ≥1 had a had a good sensitivity of 86.8% for predicting the requirement for surgical airway; while qSAT score of 3 had a good specificity of 99.9% in ruling out the need for surgical airway.ConclusionsThe qSAT score could be assessed simply using only information present upon hospital arrival to identify patients who may need a surgical airway. The utilize of qSAT score in combination with repeated evaluations on physical finding could improve outcomes in trauma patients.
Highlights
Trauma patients frequently require tracheal intubation during their initial resuscitation
Several scoring systems have been utilized to predict survival outcome and the need for massive transfusion in trauma patients [8,9,10,11,12], the prediction of Difficult tracheal intubation (DTI) remains an imperfect science as the tests fail to predict some difficult intubations, and there is little research on scoring systems predicting the need for a surgical airway in trauma patients [13]
Univariate analyses revealed that the following potential predictors were significantly associated with a surgical airway: younger age, higher proportion of males, lower proportion of having abdominal injury, and higher proportion of having injury in the following regions: face, neck, and cervical spine (C-spine)
Summary
Trauma patients frequently require tracheal intubation during their initial resuscitation. Initial airway management in trauma requires the emergent assessment of DTI and the necessity for a surgical airway as trauma patients often present with airway obstruction, respiratory failure, or shock on ED arrival. Both an early decision to intubate and rapid identification of the need to transition to the surgical airway from OTI are Hayashida et al BMC Emergency Medicine (2018) 18:48 essential concepts in trauma care. We sought to develop a novel method to and quickly estimate the need for a surgical airway in trauma patients during the initial management. The aim of this study was to develop a predictable scoring system to determine the need for a surgical airway by using a database from a large multicenter trauma registry
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