Abstract
Prehospital intubation in traumatic brain injury (TBI) focuses on limiting the effects of secondary insults such as hypoxia, but no indisputable evidence has been presented that it is beneficial for outcome. The aim of this study was to explore the characteristics of patients who undergo prehospital intubation and, in turn, if these parameters affect outcome. Patients ≥15 years admitted to the Department of Neurosurgery, Stockholm, Sweden with TBI from 2008 through 2014 were included. Data were extracted from prehospital and hospital charts, including prospectively collected Glasgow Outcome Score (GOS) after 12 months. Univariate and multivariable logistic regression models were employed to examine parameters independently correlated to prehospital intubation and outcome. A total of 458 patients were included (n = 178 unconscious, among them, n = 61 intubated). Multivariable analyses indicated that high energy trauma, prehospital hypotension, pupil unresponsiveness, mode of transportation, and distance to the hospital were independently correlated with intubation, and among them, only pupil responsiveness was independently associated with outcome. Prehospital intubation did not add independent information in a step-up model versus GOS (p = 0.154). Prehospital reports revealed that hypoxia was not the primary cause of prehospital intubation, and that the procedure did not improve oxygen saturation during transport, while an increasing distance from the hospital increased the intubation frequency. In this modern trauma cohort, prehospital intubation was not independently associated with outcome; however, hypoxia was not a common reason for prehospital intubation. Prospective trials to assess efficacy of prehospital airway intubation will be difficult due to logistical and ethical considerations.
Highlights
Traumatic brain injury (TBI) constitutes a major public health issue every year for approximately 10 million people globally [1]
During the period January first 2008 to December 31st 2014, 738 TBI patients were considered for inclusion and, out of these, 122 patients were excluded due to missing prehospital records, 75 patients due to uncertain trauma time or admittance more than 6 h after trauma, and 83 patients as they had been referred from other counties
Demographics for all patients, as well as missing data for each parameter, are presented (Table S1 in Supplementary Material). Out of these 458 patients, 178 were unconscious at the scene of accident and represented patients in potential need of prehospital airway management according to the implemented guidelines
Summary
Traumatic brain injury (TBI) constitutes a major public health issue every year for approximately 10 million people globally [1]. A large number of studies on prehospital intubation have been conducted, there are only a few on the relationship between advanced prehospital airway management and the distance to hospital. Those studies that have addressed the correlation between prehospital time duration and intubation have not uniquely focused on TBI patients [24,25,26,27]. Prehospital intubation in traumatic brain injury (TBI) focuses on limiting the effects of secondary insults such as hypoxia, but no indisputable evidence has been presented that it is beneficial for outcome. The aim of this study was to explore the characteristics of patients who undergo prehospital intubation and, in turn, if these parameters affect outcome
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