Bendinelli Cino, Ku Dominic, Nebauer Shane, King Kate L, Howard Teresa, Gruen Russel, Evans Tiffany, Fitzgerald Mark, Balogh Zsolt J
John Hunter Hospital, The University of Newcastle, Newcastle, New South Wales, Australia.
The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2018 May;88(5):455-459. doi: 10.1111/ans.14479. Epub 2018 Mar 23.
The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality.
Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay.
One hundred and ninety-two Victorian and 91 NSW patients did not differ in: demographics (males: 77% versus 79%; P = 0.7 and age: 34 (18-88) versus 33 (18-85); P = 0.7), Glasgow Coma Scale (3 (3-8) versus 5 (3-8); P = 0.07), and injury severity score (38 (26-75) versus 35 (18-75); P = 0.09), prehospital hypotension (15.4% versus 11.7%; P = 0.5) and desaturation (14.6% versus 17.5%; P = 0.5). Victorians had higher abbreviated injury scale head and neck (5 (4-5) versus 5 (3-6); P = 0.04) and more often successful PETI (85% versus 22%; P < 0.05). On logistic regression analysis, mortality did not differ among groups (31.7% versus 26.3%; P = 0.34; OR = 0.84; 95% CI: 0.38-1.86; P = 0.67). Among survivors, Victorians had longer stay in ICU (364 (231-486) versus 144 (60-336) h), a difference that persisted on gamma regression (effect = 1.58; 95% CI: 1.30-1.92; P < 0.05).
Paramedics using RSI to obtain PETI in patients with traumatic brain injury had a higher success rate. This increase in successful PETI rate was not associated with an improvement in either mortality rate or ICU length of stay.
院前气管插管（PETI）在创伤性脑损伤中的作用尚不清楚。在维多利亚州，护理人员使用快速顺序诱导（RSI）药物来辅助进行PETI，而在新南威尔士州（NSW），他们无法使用麻痹剂。我们假设RSI既能提高PETI的成功率，又能改善死亡率。
对成年初次入院患者（格拉斯哥昏迷量表评分<9分且简明损伤量表头颈部评分>2分）进行回顾性比较，这些患者分别入住维多利亚州或新南威尔士州的创伤中心，通过单因素分析和逻辑回归分析来估计死亡率和重症监护病房（ICU）住院时间的比值比。
192例维多利亚州患者和91例新南威尔士州患者在以下方面无差异：人口统计学特征（男性：77%对79%；P = 0.7；年龄：34（18 - 88）岁对33（18 - 85）岁；P = 0.7）、格拉斯哥昏迷量表评分（3（3 - 8）分对5（3 - 8）分；P = 0.07）、损伤严重程度评分（38（26 - 75）分对35（18 - 75）分；P = 0.09）、院前低血压（15.4%对11.7%；P = 0.5）和血氧饱和度下降（14.6%对17.5%；P = 0.5）。维多利亚州患者的简明损伤量表头颈部评分更高（5（4 - 5）分对5（3 - 6）分；P = 0.04），PETI成功率也更高（85%对22%；P < 0.05）。逻辑回归分析显示，两组间死亡率无差异（3
