Department of Emergency Medicine, UCSD Center for Resuscitation Science, San Diego, California 92103-8676, USA.
Prehosp Emerg Care. 2011 Apr-Jun;15(2):184-92. doi: 10.3109/10903127.2010.545473. Epub 2011 Feb 10.
Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury.
To explore the relationship between out-of-hospital intubation attempts and outcome among trauma patients with Glasgow Coma Scale (GCS) scores ≤ 8 across sites participating in the Resuscitation Outcomes Consortium (ROC).
The ROC Epistry-Trauma, an epidemiologic database of prehospital encounters with critically injured trauma victims, was used to identify emergency medical services (EMS)-treated patients with GCS scores ≤ 8. Multiple logistic regression was used to explore the association between intubation attempts and vital status at discharge, adjusting for the following covariates: age, gender, GCS score, hypotension, mechanism of injury, and ROC site. Sites were then stratified by frequency of intubation attempts and chi-square test for trend was used to associate the frequency of intubation attempts with outcome.
A total of 1,555 patients were included in this analysis; intubation was attempted in 758 of these. Patients in whom intubation was attempted had higher mortality (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 2.13-3.98, p < 0.01). However, sites with higher rates of attempted intubation had lower mortality across all trauma victims with GCS scores ≤ 8 (OR 1.40, 95% CI 1.15-1.72, p < 0.01).
Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ≤ 8. Coma Scale score.
气道管理仍然是严重受伤患者最佳护理的基本组成部分，气管插管是控制气道的明确策略。然而，多项研究记录了在院外进行插管与严重创伤性脑损伤患者死亡率增加之间存在关联。
探讨在参与复苏结果联盟（ROC）的各站点中，格拉斯哥昏迷评分（GCS）≤8 的创伤患者的院外插管尝试与结局之间的关系。
ROC Epistry-Trauma 是一个包含了危重伤员院前遭遇的流行病学数据库，利用该数据库来识别接受紧急医疗服务（EMS）治疗且 GCS 评分≤8 的患者。采用多变量逻辑回归来探索插管尝试与出院时存活状态之间的关联，调整了以下协变量：年龄、性别、GCS 评分、低血压、损伤机制和 ROC 站点。然后根据插管尝试的频率对站点进行分层，并采用趋势卡方检验来关联插管尝试的频率与结局。
共有 1555 例患者纳入了此项分析，其中 758 例患者尝试了插管。尝试插管的患者死亡率更高（校正比值比[OR]2.91，95%置信区间[CI]2.13-3.98，p<0.01）。然而，在所有 GCS 评分≤8 的创伤患者中，尝试插管率较高的站点死亡率更低（OR 1.40，95%CI1.15-1.72，p<0.01）。
尝试插管的患者校正死亡率更高。然而，在 GCS 评分≤8 的所有创伤患者整个队列中，尝试插管率较高的站点校正死亡率更低。昏迷评分。
