Tuma Mazin, El-Menyar Ayman, Abdelrahman Husham, Al-Thani Hassan, Zarour Ahmad, Parchani Ashok, Khoshnaw Sherwan, Peralta Ruben, Latifi Rifat
Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar.
Clinical Research, Section of Trauma Surgery, HGH, P.O. Box 3050, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar.
Crit Care Res Pract. 2014;2014:135986. doi: 10.1155/2014/135986. Epub 2014 Jan 16.
Objectives. To study the effect of prehospital intubation (PHI) on survival of patients with isolated severe traumatic brain injury (ISTBI). Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU). Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU). PHI group was younger in age and had lower median scene motor GCS (P = 0.001). Ventilator days and hospital length of stay (P = 0.01 and 0.006, resp.) were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%, P = 0.005). On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41-0.73) was an independent predictor for mortality. Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention.
目的。研究院前插管（PHI）对单纯性严重创伤性脑损伤（ISTBI）患者生存的影响。方法。对2008年至2011年间所有接受插管的ISTBI患者进行回顾性分析。比较在院前插管与在创伤复苏单元（TRU）插管的患者。结果。在1665例创伤性脑损伤患者中，160例符合纳入标准（105例行院前插管，55例在创伤复苏单元插管）。院前插管组年龄较轻，现场运动格拉斯哥昏迷量表（GCS）中位数较低（P = 0.001）。创伤复苏单元插管组的呼吸机使用天数和住院时间较长（分别为P = 0.01和0.006）。两组间的平均损伤严重度评分（ISS）、住院时间、初始血压、肺炎和急性呼吸窘迫综合征（ARDS）相当。院前插管组的死亡率较高（54%对31%，P = 0.005）。多因素回归分析显示，现场运动GCS（比值比0.55；95%可信区间0.41 - 0.73）是死亡率的独立预测因素。结论。基于头部简明损伤定级（AIS）和现场运动GCS，院前插管对我们组的ISTBI患者未带来生存益处。然而，需要更多研究来证实这一发现并确定可能从该干预中获益的患者。
