Association of early in-hospital endotracheal intubation with clinical outcomes in patients with traumatic coma: a multicenter observational study.

BACKGROUND

Guidelines recommend immediate endotracheal intubation for patients with a GCS score ≤ 8. However, the impact of immediate airway intubation on patient outcomes remains uncertain. This study aimed to investigate the association between endotracheal intubation in the resuscitation area and outcomes in patients with trauma and a Glasgow coma scale (GCS) score < 8.

METHODS

This study used data from the Japan Trauma Data Bank from January 2019 and December 2023. Adult patients with trauma (≥ 18 years) and a GCS score < 8 upon hospital arrival were included. Data of patients who transferred from another hospital, had prehospital intubation, had burn injuries, had early transfer to another hospital, or were admitted to centers registering < 50 patients were excluded. Endotracheal intubation included orotracheal, nasotracheal, and surgical airway placements performed in the resuscitation area. Hierarchical regression estimated hospital-level odds ratios for intubation and outcomes, adjusting for patient characteristics, comorbidities, and injury severity. Pearson correlations assessed the relationship between hospital-level intubation rates and favorable neurological outcomes.

RESULTS

Overall, 11,927 patients from 96 hospitals were analyzed, of whom 67.9% underwent endotracheal intubation in the resuscitation area. Hospital-level intubation rates varied from 0% to 93.5%. Higher hospital-level intubation rates were significantly correlated with favorable neurological outcomes (r = 0.247, p = 0.015) but not with overall survival.

CONCLUSIONS

One-third of hospitals did not adhere to standard intubation protocols. Hospital-level analysis found that endotracheal intubation in the resuscitation area in patients with a GCS score < 8 following trauma was associated with better neurological outcomes after adjusting for patient characteristics and injury severity. These findings suggest that monitoring immediate intubation rates serves as a quality indicator of institutional trauma care capability; however, further research is warranted to more fully understand the direct effects of early intubation on patient outcomes.