title: The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less.
abstract: BACKGROUND
  Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury.
  
  
  OBJECTIVE
  To explore the relationship between out-of-hospital intubation attempts and outcome among trauma patients with Glasgow Coma Scale (GCS) scores ≤ 8 across sites participating in the Resuscitation Outcomes Consortium (ROC).
  
  
  METHODS
  The ROC Epistry-Trauma, an epidemiologic database of prehospital encounters with critically injured trauma victims, was used to identify emergency medical services (EMS)-treated patients with GCS scores ≤ 8. Multiple logistic regression was used to explore the association between intubation attempts and vital status at discharge, adjusting for the following covariates: age, gender, GCS score, hypotension, mechanism of injury, and ROC site. Sites were then stratified by frequency of intubation attempts and chi-square test for trend was used to associate the frequency of intubation attempts with outcome.
  
  
  RESULTS
  A total of 1,555 patients were included in this analysis; intubation was attempted in 758 of these. Patients in whom intubation was attempted had higher mortality (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 2.13-3.98, p < 0.01). However, sites with higher rates of attempted intubation had lower mortality across all trauma victims with GCS scores ≤ 8 (OR 1.40, 95% CI 1.15-1.72, p < 0.01).
  
  
  CONCLUSIONS
  Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ≤ 8. Coma Scale score.
authors.affiliation: Department of Emergency Medicine, UCSD Center for Resuscitation Science, San Diego, California 92103-8676, USA. davismd@cox.net
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.forename: Kent M
authors.initials: KM
authors.lastname: Koprowicz
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: Mohamud
authors.initials: M
authors.lastname: Daya
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Ian
authors.initials: I
authors.lastname: Stiell
authors.forename: Graham
authors.initials: G
authors.lastname: Nichol
authors.forename: Shannon
authors.initials: S
authors.lastname: Stephens
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dreyer
authors.forename: Joseph
authors.initials: J
authors.lastname: Minei
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Kerby
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States