C Schoeneberg1, A Wegner2, M D Kauther2, M Stuermer2, T Probst3, S Lendemans4. 1. Klinik für Unfallchirurgie und Orthopädie, Alfried Krupp Krankenhaus Essen, Hellweg 100, 45276, Essen, Deutschland. carsten.schoeneberg@krupp-krankenhaus.de. 2. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland. 3. Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Städtische Kliniken Neuss, Neuss, Deutschland. 4. Klinik für Unfallchirurgie und Orthopädie, Alfried Krupp Krankenhaus Essen, Hellweg 100, 45276, Essen, Deutschland.
Abstract
BACKGROUND: Training programs for the treatment of trauma patients generally recommend establishing a secure airway if the patient presents with a Glasgow coma scale (GCS) score of less than 9; however, the evidence for its effectiveness is rather sparse. This study analyzed the effect of preclinical intubation on mortality of patients with a GCS <9 in an emergency medical situation. METHODS: This retrospective analysis included patients who were primarily admitted to a German level 1 trauma center between 2002 and 2012 with an injury severity score (ISS) ≥ 16, a GCS < 9 and primary transport from the site of the accident. Data were collected from the trauma registry of the German Society for Trauma Surgery and from hospital records. A total of 455 patients were included and a matched-pair analysis of 62 patients was conducted. RESULTS: Both analytical methods showed no significant reduction in mortality rate after prehospital intubation. In the retrospective analysis intubated patients presented with a significantly lower systolic blood pressure on admission, received a higher amount of fluid volume at all phases of treatment and arrived at the hospital after a prolonged rescue time. In the matched-pair analysis, intubated patients also received a higher amount of fluid volume and showed better peripheral oxygen saturation on admission. No further differences between the groups could be found. CONCLUSION: It appears that preclinical intubation in trauma patients with a GCS < 9 does not result in a better outcome. The preclinical intubation resulted in a reduced systolic blood pressure on arrival at hospital, a prolonged preclinical rescue time and a greater amount of infused fluid volume.
BACKGROUND: Training programs for the treatment of traumapatients generally recommend establishing a secure airway if the patient presents with a Glasgow coma scale (GCS) score of less than 9; however, the evidence for its effectiveness is rather sparse. This study analyzed the effect of preclinical intubation on mortality of patients with a GCS <9 in an emergency medical situation. METHODS: This retrospective analysis included patients who were primarily admitted to a German level 1 trauma center between 2002 and 2012 with an injury severity score (ISS) ≥ 16, a GCS < 9 and primary transport from the site of the accident. Data were collected from the trauma registry of the German Society for Trauma Surgery and from hospital records. A total of 455 patients were included and a matched-pair analysis of 62 patients was conducted. RESULTS: Both analytical methods showed no significant reduction in mortality rate after prehospital intubation. In the retrospective analysis intubated patients presented with a significantly lower systolic blood pressure on admission, received a higher amount of fluid volume at all phases of treatment and arrived at the hospital after a prolonged rescue time. In the matched-pair analysis, intubated patients also received a higher amount of fluid volume and showed better peripheral oxygen saturation on admission. No further differences between the groups could be found. CONCLUSION: It appears that preclinical intubation in traumapatients with a GCS < 9 does not result in a better outcome. The preclinical intubation resulted in a reduced systolic blood pressure on arrival at hospital, a prolonged preclinical rescue time and a greater amount of infused fluid volume.
Entities:
Keywords:
Glascow coma scale; Intubation; Mortality; Severely injured; Trauma
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