The Relationship Between Out-of-Hospital Airway Management and Outcome Among Trauma Patients with Glasgow Coma Scale Score 8 or Less

Daniel Davis
Kent M. Koprowicz, University of Washington
Craig Newgard
Mohamud Daya
Ian Stiell
Graham Nichol
Shannon Stephens
Jonathan Dreyer
Joseph Minei
Jeffrey Kerby

Abstract

Background: 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 early intubation and increased mortality. Objectives: To explore the relationship between intubation attempts and outcome across sites participating in the Resuscitation Outcomes Consortium (ROC). Methods: The ROC Epistry – Trauma, an epidemiologic database of prehospital encounters with critically injured trauma victims, was used to identify EMS-treated patients with Glasgow Coma Scale (GCS) score ≤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 used to associate the frequency of intubation attempts with outcome. Results: 1,555 patients were included in this analysis; intubation was attempted in 758 (49%) of these. Patients in whom intubation was attempted had higher mortality (adjusted odds ratio 2.91, 95% 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 ≤8 (OR 1.40, 95% CI 1.15-1.72, p<0.01). Conclusions: 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 ≤8.