Emergent endotracheal intubation and mortality in traumatic brain injury.

TitleEmergent endotracheal intubation and mortality in traumatic brain injury.
Publication TypeJournal Article
Year of Publication2008
AuthorsDenninghoff KR, Griffin MJ, Bartolucci AA, Lobello SG, Fine PR
JournalWest J Emerg Med
Volume9
Issue4
Pagination184-9
Date Published2008 Nov
ISSN Number1936-900X
Abstract

OBJECTIVES: To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury while controlling for injury severity.

METHODS: Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model.

RESULTS: The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4-21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2-10.9).

CONCLUSIONS: This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field.

Alternate JournalWest J Emerg Med
PubMed ID19561742
PubMed Central IDPMC2672276
Faculty Reference: 
Kurt Denninghoff, MD