Abstract 17: Prehospital Intubation Results in Increases in Pulmonary Infection in Traumatically Injured Patients
Introduction: Infection is a major cause of morbidity and mortality in multisystem trauma. Sources of infection in trauma are not well understood. The impact of invasive prehospital procedures, including intubation and needle thoracostomy, on the incidence of infection is not known.
Hypothesis: We hypothesized that trauma patients who are exposed to prehospital intubation and needle thoracostomy will suffer higher rates of pneumonia and empyema compared to no exposure or exposure to the same procedures performed in the hospital.
Methods: This is an observational cohort study of data previously collected from the ROC hypertonic saline (HS) trial. Patients were included if they were found to have an injury that resulted in shock, traumatic brain injury or both. Patients were excluded if they had an infection detected or died within the first 24 hours after injury, or infection data were missing. Descriptive statistics were calculated and unadjusted and adjusted logistic regression was used to estimate the odds ratio of having an infection if exposed in the prehospital setting compared to exposure in the hospital or no exposure. Multivariable models were adjusted for AIS score, type of injury, age, and HS treatment group.
Results: Of 2222 patients enrolled in HS, 1676 patients met enrolment criteria. Patients suffered either pneumonia or empyema 4.5% of the time. Compared to no intubation, intubation in the prehospital setting was associated with a 7.7 fold increase (95% C.I. 2.0, 23.0, p=0.003) in the adjusted odds of having pneumonia, while in hospital intubation was associated with a 4.8 fold increase (95% C.I. 1.4, 16.6, p=0.01). Compared to no or in hospital needle thoracostomy, prehospital needle thoracostomy was not associated with a statistically significant increase in empyema or pneumonia (OR 0.34, 95% CI 0.05, 2.05, p=0.29).
Conclusion: In this study, exposure to intubation in the prehospital setting was associated with an increase in pneumonia, while prehospital exposure to needle thoracostomy was not associated with an increase in empyema. Additional research is needed to determine if the increased risk of pulmonary infections associated with prehospital intubation is due to prehospital airway intervention or confounded by other factors.
- © 2012 by American Heart Association, Inc.