title: Medical conditions associated with out-of-hospital endotracheal intubation.
abstract: BACKGROUND
  While prior studies describe the clinical presentation of patients requiring paramedic out-of-hospital endotracheal intubation (ETI), limited data characterize the underlying medical conditions or comorbidities.
  
  
  OBJECTIVE
  To characterize the medical conditions and comorbidities of patients receiving successful paramedic out-of-hospital ETI.
  
  
  METHODS
  We used Pennsylvania statewide emergency medical services (EMS) clinical data, including all successful ETIs performed during 2003-2005. Using multiple imputation triple-match algorithms, we probabilistically linked EMS ETI to statewide death and hospital admission data. Each hospitalization record contained one primary and up to eight secondary diagnoses, classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We determined the proportion of patients in each major ICD-9-CM diagnostic group and subgroup. We calculated the Charlson Comorbidity Index score for each patient. Using binomial proportions with confidence intervals (CIs), we analyzed the data and combined imputed results using Rubin's method.
  
  
  RESULTS
  Across the imputed sets, we linked 25,733 (77.7% linkage) successful ETIs to death or hospital records; 56.3% patients died before and 43.7% survived to hospital admission. Of the 14,478 patients who died before hospital admission, most (92.7%; 95% CI: 92.5-93.3%) had presented to EMS in cardiac arrest. Of the 11,255 hospitalized patents, the leading primary diagnoses were circulatory diseases (32.0%; 95% CI: 30.2-33.7%), respiratory diseases (22.8%; 95% CI: 21.9-23.7%), and injury or poisoning (25.2%; 95% CI: 22.7-27.8%). Prominent primary diagnosis subgroups included asphyxia and respiratory failure (15.2%), traumatic brain injury and skull fractures (11.3%), acute myocardial infarction and ischemic heart disease (10.9%), poisonings and drug and alcohol disorders (6.7%), dysrhythmias (6.7%), hemorrhagic and nonhemorrhagic stroke (5.9%), acute heart failure and cardiomyopathies (5.6%), pneumonia and aspiration (4.9%), and sepsis, septicemia, and septic shock (3.2%). Most of the admitted ETI patients had a secondary circulatory (70.8%), respiratory (61.4%), or endocrine, nutritional, or metabolic (51.4%) secondary diagnosis. The mean Charlson Index score was 1.6 (95% CI: 1.5-1.7).
  
  
  CONCLUSIONS
  The majority of successful paramedic ETIs occur on patients with cardiac arrest and circulatory and respiratory conditions. Injuries, poisonings, and other conditions compromise smaller but important portions of the paramedic ETI pool. Patients undergoing ETI have multiple comorbidities. These findings may guide the systemic planning of paramedic airway management care and education.
authors: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA.
authors: Henry E
authors: HE
authors: Wang
authors: G K
authors: GK
authors: Balasubramani
authors: Lawrence J
authors: LJ
authors: Cook
authors: Donald M
authors: DM
authors: Yealy
authors: Judith R
authors: JR
authors: Lave
references: Circulation. 2009 May 19;119(19):2597-605
references: 19414637
references: Prehosp Emerg Care. 2006 Apr-Jun;10(2):261-71
references: 16531387
references: Methods Inf Med. 2001 Jul;40(3):196-203
references: 11501632
references: Prehosp Emerg Care. 2006 Oct-Dec;10(4):430-9
references: 16997770
references: Acad Emerg Med. 2010 Sep;17(9):987-8
references: 20836780
references: J Trauma. 2003 Mar;54(3):444-53
references: 12634522
references: Ann Emerg Med. 2008 Jul;52(1):13-4
references: 18565378
references: Ann Emerg Med. 2002 Aug;40(2):159-67
references: 12140494
references: Prehosp Emerg Care. 2010 Jul-Sep;14(3):283
references: 20507218
references: Stat Med. 1991 Apr;10(4):585-98
references: 2057657
references: Ann Emerg Med. 2001 Jan;37(1):32-7
references: 11145768
references: Acad Emerg Med. 2006 Jan;13(1):69-75
references: 16365326
references: Resuscitation. 2009 Jan;80(1):50-5
references: 18952357
references: Ann Emerg Med. 2000 Jun;35(6):585-91
references: 10828772
references: Am J Public Health. 1992 Mar;82(3):441-4
references: 1536365
references: J Emerg Med. 2003 Oct;25(3):251-6
references: 14585451
references: JAMA. 2000 Feb 9;283(6):783-90
references: 10683058
references: Rev Saude Publica. 2008 Dec;42(6):1097-100
references: 18833380
references: BMJ. 1989 Sep 16;299(6701):709-13
references: 2508883
references: Acad Emerg Med. 2010 Sep;17(9):918-25
references: 20836771
references: J Clin Epidemiol. 1992 Jun;45(6):613-9
references: 1607900
references: Resuscitation. 2003 Jul;58(1):49-58
references: 12867309
references: Ann Emerg Med. 2008 Sep;52(3):232-41, 241.e1
references: 18387700
references: Prehosp Emerg Care. 2011 Jan-Mar;15(1):44-9
references: 20858132
references: J Trauma. 2004 Jul;57(1):1-8; discussion 8-10
references: 15284540
references: J Trauma. 1996 May;40(5):805-9
references: 8614084
references: Ann Emerg Med. 2010 Jun;55(6):527-537.e6
references: 20138400
references: Lancet. 2009 Jul 25;374(9686):293-300
references: 19573904
references: BMJ. 1990 Jul 7;301(6742):17-9
references: 2383701
references: Prehosp Emerg Care. 2001 Jan-Mar;5(1):10-8
references: 11194061
references: Acad Emerg Med. 2010 Sep;17(9):926-31
references: 20836772
references: J Pediatr. 2009 Feb;154(2):272-7
references: 18822431
references: Health Aff (Millwood). 2006 Mar-Apr;25(2):501-9
references: 16522604
references: Br Med J (Clin Res Ed). 1988 Feb 20;296(6621):583-5
references: 3126913
references: Prehosp Emerg Care. 2010 Jul-Sep;14(3):377-401
references: 20507222
references: J Am Med Inform Assoc. 1997 May-Jun;4(3):233-7
references: 9147342
references: Resuscitation. 2009 Feb;80(2):199-203
references: 19081171
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: JAMA. 2008 Mar 12;299(10):1158-65
references: 18334691
references: Ann Emerg Med. 2006 Jun;47(6):532-41
references: 16713780
references: Prehosp Emerg Care. 2011 Apr-Jun;15(2):184-92
references: 21309705
references: Ann Emerg Med. 1995 Apr;25(4):525-34
references: 7710161
references: Stat Med. 1995 Mar 15-Apr 15;14(5-7):491-8
references: 7792443
references: Ann Emerg Med. 2004 Nov;44(5):439-50
references: 15520702
references: BMC Med Inform Decis Mak. 2008 Nov 17;8:52
references: 19014622