The Impact of Prehospital Intubation With and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less

Journal of Neurosurgical Anesthesiology
Michael HoffmannTraumaRegister DGU of the German Trauma Society (DGU)

Abstract

Although unconsciousness (Glasgow Coma Scale [GCS] 3 to 8) necessitates intubation according national guidelines, there is a notable lack of evidence to support this approach. This study evaluates the impact on outcome of prehospital intubation with and without sedation in trauma patients with a GCS of ≤8. A retrospective cohort analysis of severely injured trauma patients registered in the TraumaRegister DGU of the German Trauma Society (DGU) from 2002 to 2013 was conducted. Only directly admitted patients alive on admission and with a GCS of ≤8 at the scene were included. The observed outcome was matched with the expected outcome deriving from the Revised Injury Severity Classification, version II (RISC-II). Furthermore, a Standardized Mortality Ratio (SMR) was calculated for various subgroups. Early neurological outcome was classified using the Glasgow Outcome Scale. A total of 21,242 patients fulfilled the study inclusion criteria. A total of 18,975 patients (89.3%) received prehospital intubation. Intubation rates were continuously increasing with decreasing GCS score values. Difference between observed and expected mortality was lower in intubated patients (42.2% [95% confidence interval (CI), 41.5%-42.9%]; RISC-II progno...Continue Reading

References

Jul 13, 1974·Lancet·G Teasdale, B Jennett
Feb 1, 1993·The Journal of Trauma·R M ChesnutM A Foulkes
Sep 30, 1998·The Journal of Emergency Medicine·T HatleyD Strong
Apr 26, 2000·The Journal of Trauma·M EcksteinR Palmer
Jun 23, 2000·The Journal of Emergency Medicine·G L Sternbach
Jan 30, 2004·Annals of Emergency Medicine·Michelle R GillSteven M Green
May 7, 2004·The Journal of Trauma·Samir M FakhryUNKNOWN IRTC Neurotrauma Task Force
Nov 3, 2004·Annals of Emergency Medicine·Henry E WangDonald M Yealy
Jun 15, 2007·The Journal of Trauma·Keir J WarnerEileen M Bulger
Apr 23, 2008·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Daniel P Davis
Mar 11, 2009·The Journal of Emergency Medicine·Russell Duncan, Shobhan Thakore
Jun 6, 2013·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Blair L BighamLaurie J Morrison
Dec 26, 2013·The Journal of Trauma and Acute Care Surgery·Dennis KimRaul Coimbra
Nov 15, 2014·Critical Care : the Official Journal of the Critical Care Forum·Rolf LeferingBertil Bouillon
Oct 7, 2015·Neurocritical Care·David B SederBecky Riggs

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Citations

Mar 10, 2018·Journal of Neurosurgical Anesthesiology·Jeffrey J Pasternak, William L Lanier
Jan 30, 2019·Current Opinion in Anaesthesiology·Corey Scher, Robert Mansky
Jul 25, 2019·The Journal of Trauma and Acute Care Surgery·Jürgen KnappMichael Bernhard
Mar 1, 2019·Current Opinion in Anaesthesiology·Robert Mansky, Corey Scher
Jan 12, 2019·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Pedram EmamiUNKNOWN TraumaRegister DGU® of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; DGU)
Oct 3, 2019·Critical Care Nurse·Bryan Boling, Tasha R Groves
Aug 27, 2019·Journal of the Intensive Care Society·Emily Frostick, Christopher Johnson
May 20, 2020·Frontiers in Neurology·Lennart RiemannUNKNOWN Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participa

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