Abstract 4: What Is The Impact Of Prehospital Intubation On Survival In Patients With Moderate To Severe Traumatic Brain Injury?
Introduction: Prehospital intubation is the standard of care for patients with Glasgow Coma Score (GCS) < 9 but some have questioned its usefulness and safety. We compared in-hospital mortality for patients with moderate to severe traumatic brain injury (TBI) who underwent prehospital endotracheal intubation (P-ETI) or emergency department endotracheal intubation (ED-ETI).
Methods: We studied a prospective cohort of patients from the Ontario Prehospital Advance Life Support - Major Trauma Study who had moderate to severe TBI (defined as head abbreviated injury score ≥ 3) and underwent either P-ETI or ED-ETI. We compared baseline characteristics, prehospital management and outcomes between these two groups. For the primary outcome, in-hospital mortality, we calculated unadjusted and adjusted odds ratios (OR).
Results: We included 299 adult patients from 17 Canadian cities. Baseline characteristics of the P-ETI and ED-ETI groups were: mean age 44.1 and 42.4; 64% and 70% male; median on-scene GCS 3 and 6; GCS <9 93% and 69%; median on-scene systolic BP 98.5 and 120; mean injury severity score 35 and 31.5; median scene time 23 and 15 minutes; median hospital length of stay 4 and 17 days; mortality 69% and 35%. We observed a significant association between P-ETI and in-hospital mortality. Unadjusted OR and 95% confidence intervals for P-ETI was 4.15 (2.243 – 7.691) (p=<0.0001). After adjusting for age, gender, injury severity score, head abbreviated injury score, scene GCS and systolic BP, the OR was 3.115 (1.534 – 6.325) (p=0.0157).
Conclusions: We observed higher in-hospital mortality in patients with moderate to severe TBI who were intubated in the prehospital setting compared to those who were intubated in the emergency department, even after adjusting for potential confounders. Further study is needed to determine the whether this worse outcome is a function of patient selection, prehospital intubation or how the intubation was performed.