title: Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma.
abstract: OBJECTIVE
  Application of the Trauma and Injury Severity Score (TRISS) to a trauma population identifies patients with 'unexpected survival'. This study used TRISS analysis to identify 'unexpected survivors' suffering major thoracic trauma, who survived to hospital discharge. Further analysis determined prehospital interventions that appeared to contribute to 'unexpected survival'.
  
  
  METHODS
  The present study was a single-centre, retrospective case review with comparative statistical analysis. Patients were identified from the Alfred Trauma Registry between 1 July 2002 and 30 June 2003.
  
  
  RESULTS
  There were 336 adult trauma patients treated at The Alfred Trauma Centre with an Injury Severity Score >15 (major trauma) and at least one thoracic Anatomical Injury Score of 3 (severe) or greater. Of the eligible patients, 322/336 (95.8%, 95%[confidence interval] CI 95.1-96.5%) had complete data available for analysis. The study population mortality was 42/322 (13.0%, 95% CI 12.3-13.7%). There were 20 'unexpected survivors' (5.9%) and 5 (1.5%) 'unexpected deaths' on TRISS analysis. Chest decompression and/or endotracheal intubation prehospital was performed on 16/20 'unexpected survivors'. GCS for 'unexpected survivors' and 'expected deaths' (3.8 vs 3.5, P = 0.27) was not a predictor of survival. Respiratory rate per minute (16.2 vs 8.8, P = 0.01) and systolic blood pressure - mmHg (98 vs 80, P = 0.03) were significantly greater in the 'unexpected survivors' group compared with the 'expected death' group.
  
  
  CONCLUSIONS
  For patients sustaining severe thoracic blunt trauma, prehospital intubation and chest decompression appear to be associated with unexpected survival. A low GCS at scene is not predictive of 'unexpected survival' or 'expected death'.
authors.affiliation: Emergency and Trauma Centre, The Alfred, Prahran, Victoria, Australia. nathan.bushby@southernhealth.org.au
authors.forename: Nathan
authors.initials: N
authors.lastname: Bushby
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Silvana
authors.initials: S
authors.lastname: Marasco
authors.forename: Adam
authors.initials: A
authors.lastname: Bystrzycki
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003664:Decompression / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000401:mortality* / Q000628:therapy*; D014739:Victoria / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000628:therapy*