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Should Trauma Patients with a Glasgow Coma Scale Score of 3 Be Intubated Prior to Hospital Arrival?

Published online by Cambridge University Press:  28 June 2012

Charlene B. Irvin ,
Susan Szpunar ,
Lauren A. Cindrich ,
Justin Walters  and
Robert Sills
Charlene B. Irvin*
Affiliation:
St. John Hosptial and Medical Center, Detroit, Michigan, USA
Susan Szpunar
Affiliation:
St. John Hosptial and Medical Center, Detroit, Michigan, USA
Lauren A. Cindrich
Affiliation:
Wayne State University, Detroit, Michigan, USA
Justin Walters
Affiliation:
St. John Hosptial and Medical Center, Detroit, Michigan, USA
Robert Sills
Affiliation:
St. John Hosptial and Medical Center, Detroit, Michigan, USA
*
50572 Jefferson Avenue, New Baltimore, Michigan 48047, USA E-mail: cbi@123.net
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Abstract

Introduction:

Previous studies of heterogeneous populations (Glasgow Coma Scale (GCS) scores <9) suggest that endotracheal intubaton of trauma patients prior to hospital arrival (i.e., prehospital intubated) is associated with an increased mortality compared to those patients not intubated in the pre-hospital setting. Deeply comatose patients (GCS = 3) represent a unique population of severely traumatized patients and may benefit from intubation in the prehospital setting. The objective of this study was to compare mortality rates of severely comatose patients (scene GCS = 3) with prehospital endotracheal intubation to those intubated at the hospital.

Methods:

Using the National Trauma Data Bank (V. 6.2), the following variables were analyzed retrospectively: (1) age; (2) injury type (blunt or penetrating); (3) Injury Severity Score (ISS); (4) scene GCS = 3 (scored prior to intubation/without sedation); (5) emergency department GCS score; (6) arrival emergency department intubation status; (7) first systolic blood pressure in the emergency department (>0); (8) discharge status (alive or dead); (9) Abbreviated Injury Scale Score (AIS); and (10) AIS body region.

Results:

Of the 10,948 patients analyzed, 23% (2,491/10,948) were endotracheally intubated in a prehospital setting. Mortality rate for those hospital intubated was 35% vs. 62% for those with prehospital intubation (p <0.0001); mean ISS scores 24.2 ±16.0 vs. 31.6 ±16.2, respectively (p <0.0001). Using logistic regression, controlling for first systolic blood pressure, ISS, emergency department GCS, age, and type of trauma, those with prehospital intubation were more likely to die (OR = 1.9, 95% CI = 1.7−2.2). For patients with only head AIS scores (no other body region injury, n = 1,504), logistic regression (controlling for all other variables) indicated that those with prehospital intubation were still more likely to die (OR = 2.0. 95% CI = 1.4−2.9).

Conclusions:

Prehospital endotracheal intubation is associated with an increased mortality in completely comatose trauma patients (GCS = 3). Although the exact reasons for this remain unclear, these results support other studies and suggest the need for future research and re-appraisal of current policies for prehospital intubation in these severely traumatized patients.

Keywords

endotracheal intubationGlasgow Coma Scaleintubationprehospitaltrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 6 , December 2010 , pp. 541 - 546
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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