A tale of two cities: prehospital intubation with or without paralysing agents for traumatic brain injury

Cino Bendinelli, Dominic Ku, Shane Nebauer, Kate L. King, Teresa Howard, Russel Gruen, Tiffany Evans, Mark Fitzgerald, Zsolt J. Balogh

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality. Methods: Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay. Results: One hundred and ninety-two Victorian and 91 NSW patients did not differ in: demographics (males: 77% versus 79%; P = 0.7 and age: 34 (18–88) versus 33 (18–85); P = 0.7), Glasgow Coma Scale (3 (3–8) versus 5 (3–8); P = 0.07), and injury severity score (38 (26–75) versus 35 (18–75); P = 0.09), prehospital hypotension (15.4% versus 11.7%; P = 0.5) and desaturation (14.6% versus 17.5%; P = 0.5). Victorians had higher abbreviated injury scale head and neck (5 (4–5) versus 5 (3–6); P = 0.04) and more often successful PETI (85% versus 22%; P < 0.05). On logistic regression analysis, mortality did not differ among groups (31.7% versus 26.3%; P = 0.34; OR = 0.84; 95% CI: 0.38–1.86; P = 0.67). Among survivors, Victorians had longer stay in ICU (364 (231–486) versus 144 (60–336) h), a difference that persisted on gamma regression (effect = 1.58; 95% CI: 1.30–1.92; P < 0.05). Conclusion: Paramedics using RSI to obtain PETI in patients with traumatic brain injury had a higher success rate. This increase in successful PETI rate was not associated with an improvement in either mortality rate or ICU length of stay.

Original languageEnglish
Pages (from-to)455-459
Number of pages5
JournalANZ Journal of Surgery
Volume88
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • intubation
  • prehospital
  • traumatic brain injury

Cite this

Bendinelli, Cino ; Ku, Dominic ; Nebauer, Shane ; King, Kate L. ; Howard, Teresa ; Gruen, Russel ; Evans, Tiffany ; Fitzgerald, Mark ; Balogh, Zsolt J. / A tale of two cities : prehospital intubation with or without paralysing agents for traumatic brain injury. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 5. pp. 455-459.
@article{35a2f72a6947469b84a980dbfb02c3b8,
title = "A tale of two cities: prehospital intubation with or without paralysing agents for traumatic brain injury",
abstract = "Background: The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality. Methods: Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay. Results: One hundred and ninety-two Victorian and 91 NSW patients did not differ in: demographics (males: 77{\%} versus 79{\%}; P = 0.7 and age: 34 (18–88) versus 33 (18–85); P = 0.7), Glasgow Coma Scale (3 (3–8) versus 5 (3–8); P = 0.07), and injury severity score (38 (26–75) versus 35 (18–75); P = 0.09), prehospital hypotension (15.4{\%} versus 11.7{\%}; P = 0.5) and desaturation (14.6{\%} versus 17.5{\%}; P = 0.5). Victorians had higher abbreviated injury scale head and neck (5 (4–5) versus 5 (3–6); P = 0.04) and more often successful PETI (85{\%} versus 22{\%}; P < 0.05). On logistic regression analysis, mortality did not differ among groups (31.7{\%} versus 26.3{\%}; P = 0.34; OR = 0.84; 95{\%} CI: 0.38–1.86; P = 0.67). Among survivors, Victorians had longer stay in ICU (364 (231–486) versus 144 (60–336) h), a difference that persisted on gamma regression (effect = 1.58; 95{\%} CI: 1.30–1.92; P < 0.05). Conclusion: Paramedics using RSI to obtain PETI in patients with traumatic brain injury had a higher success rate. This increase in successful PETI rate was not associated with an improvement in either mortality rate or ICU length of stay.",
keywords = "intubation, prehospital, traumatic brain injury",
author = "Cino Bendinelli and Dominic Ku and Shane Nebauer and King, {Kate L.} and Teresa Howard and Russel Gruen and Tiffany Evans and Mark Fitzgerald and Balogh, {Zsolt J.}",
year = "2018",
month = "5",
day = "1",
doi = "10.1111/ans.14479",
language = "English",
volume = "88",
pages = "455--459",
journal = "ANZ Journal of Surgery",
issn = "1445-1433",
publisher = "Wiley-Blackwell",
number = "5",

}

A tale of two cities : prehospital intubation with or without paralysing agents for traumatic brain injury. / Bendinelli, Cino; Ku, Dominic; Nebauer, Shane; King, Kate L.; Howard, Teresa; Gruen, Russel; Evans, Tiffany; Fitzgerald, Mark; Balogh, Zsolt J.

In: ANZ Journal of Surgery, Vol. 88, No. 5, 01.05.2018, p. 455-459.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A tale of two cities

T2 - prehospital intubation with or without paralysing agents for traumatic brain injury

AU - Bendinelli, Cino

AU - Ku, Dominic

AU - Nebauer, Shane

AU - King, Kate L.

AU - Howard, Teresa

AU - Gruen, Russel

AU - Evans, Tiffany

AU - Fitzgerald, Mark

AU - Balogh, Zsolt J.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality. Methods: Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay. Results: One hundred and ninety-two Victorian and 91 NSW patients did not differ in: demographics (males: 77% versus 79%; P = 0.7 and age: 34 (18–88) versus 33 (18–85); P = 0.7), Glasgow Coma Scale (3 (3–8) versus 5 (3–8); P = 0.07), and injury severity score (38 (26–75) versus 35 (18–75); P = 0.09), prehospital hypotension (15.4% versus 11.7%; P = 0.5) and desaturation (14.6% versus 17.5%; P = 0.5). Victorians had higher abbreviated injury scale head and neck (5 (4–5) versus 5 (3–6); P = 0.04) and more often successful PETI (85% versus 22%; P < 0.05). On logistic regression analysis, mortality did not differ among groups (31.7% versus 26.3%; P = 0.34; OR = 0.84; 95% CI: 0.38–1.86; P = 0.67). Among survivors, Victorians had longer stay in ICU (364 (231–486) versus 144 (60–336) h), a difference that persisted on gamma regression (effect = 1.58; 95% CI: 1.30–1.92; P < 0.05). Conclusion: Paramedics using RSI to obtain PETI in patients with traumatic brain injury had a higher success rate. This increase in successful PETI rate was not associated with an improvement in either mortality rate or ICU length of stay.

AB - Background: The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality. Methods: Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay. Results: One hundred and ninety-two Victorian and 91 NSW patients did not differ in: demographics (males: 77% versus 79%; P = 0.7 and age: 34 (18–88) versus 33 (18–85); P = 0.7), Glasgow Coma Scale (3 (3–8) versus 5 (3–8); P = 0.07), and injury severity score (38 (26–75) versus 35 (18–75); P = 0.09), prehospital hypotension (15.4% versus 11.7%; P = 0.5) and desaturation (14.6% versus 17.5%; P = 0.5). Victorians had higher abbreviated injury scale head and neck (5 (4–5) versus 5 (3–6); P = 0.04) and more often successful PETI (85% versus 22%; P < 0.05). On logistic regression analysis, mortality did not differ among groups (31.7% versus 26.3%; P = 0.34; OR = 0.84; 95% CI: 0.38–1.86; P = 0.67). Among survivors, Victorians had longer stay in ICU (364 (231–486) versus 144 (60–336) h), a difference that persisted on gamma regression (effect = 1.58; 95% CI: 1.30–1.92; P < 0.05). Conclusion: Paramedics using RSI to obtain PETI in patients with traumatic brain injury had a higher success rate. This increase in successful PETI rate was not associated with an improvement in either mortality rate or ICU length of stay.

KW - intubation

KW - prehospital

KW - traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=85044295188&partnerID=8YFLogxK

U2 - 10.1111/ans.14479

DO - 10.1111/ans.14479

M3 - Article

VL - 88

SP - 455

EP - 459

JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

IS - 5

ER -