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European Journal of Trauma and Emergency Surgery

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27.08.2016 | Original Article

Prehospital intubation for isolated severe blunt traumatic brain injury: worse outcomes and higher mortality

verfasst von: Tobias Haltmeier, Elizabeth Benjamin, Stefano Siboni, Evren Dilektasli, Kenji Inaba, Demetrios Demetriades

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2017

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Abstract

Purpose

Prehospital endotracheal intubation (ETI) for traumatic brain injury (TBI) is a controversial issue. The aim of this study was to investigate the effect of prehospital ETI in patients with TBI.

Methods

Cohort-matched study using the US National Trauma Data Bank (NTDB) 2008–2012. Patients with isolated severe blunt TBI (AIS head ≥3, AIS chest/abdomen <3) and a field GCS ≤8 were extracted from NTDB. A 1:1 matching of patients with and without prehospital ETI was performed. Matching criteria were sex, age, exact field GCS, exact AIS head, field hypotension, field cardiac arrest, and the brain injury type (according PREDOT-code). The matched cohorts were compared with univariable and multivariable regression analysis.

Results

A total of 27,714 patients were included. Matching resulted in 8139 cases with and 8139 cases without prehospital ETI. Prehospital ETI was associated with significantly longer scene (median 9 vs. 8 min, p < 0.001) and transport times (median 26 vs. 19 min, p < 0.001), lower Emergency Department (ED) GCS scores (in patients without sedation; mean 3.7 vs. 3.9, p = 0.026), more ventilator days (mean 7.3 vs. 6.9, p = 0.006), longer ICU (median 6.0 vs. 5.0 days, p < 0.001) and total hospital length of stay (median 10.0 vs. 9.0 days, p < 0.001), and higher in-hospital mortality (31.4 vs. 27.5 %, p < 0.001). In regression analysis prehospital ETI was independently associated with lower ED GCS scores (RC −4.213, CI −4.562/−3.864, p < 0.001) and higher in-hospital mortality (OR 1.399, CI 1.205/1.624, p < 0.001).

Conclusion

In this large cohort-matched analysis, prehospital ETI in patients with isolated severe blunt TBI was independently associated with lower ED GCS scores and higher mortality.

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Titel: Prehospital intubation for isolated severe blunt traumatic brain injury: worse outcomes and higher mortality
verfasst von: Tobias Haltmeier
Elizabeth Benjamin
Stefano Siboni
Evren Dilektasli
Kenji Inaba
Demetrios Demetriades
Publikationsdatum: 27.08.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 6/2017
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-016-0718-x

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Prehospital intubation for isolated severe blunt traumatic brain injury: worse outcomes and higher mortality

Abstract

Purpose

Methods

Results

Conclusion

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Methods

Results

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