title: Prehospital intubation of the moderately injured patient: a cause of morbidity? A matched-pairs analysis of 1,200 patients from the DGU Trauma Registry.
abstract: BACKGROUND
  Hypoxia and hypoxemia can lead to an unfavorable outcome after severe trauma, by both direct and delayed mechanisms. Prehospital intubation is meant to ensure pulmonary gas exchange. Limited evidence exists regarding indications for intubation after trauma. The aim of this study was to analyze prehospital intubation as an independent risk factor for the posttraumatic course of moderately injured patients. Therefore, only patients who, in retrospect, would not have required intubation were included in the matched-pairs analysis to evaluate the risks related to intubation.
  
  
  METHODS
  The data of 42,248 patients taken from the trauma registry of the German Association for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie (DGU)) were analyzed. Patients who met the following criteria were included: primary admission to a hospital; Glasgow Coma Scale (GCS) of 13 to 15; age 16 years or older; maximum injury severity per body region (AIS) ≤ 3; no administration of packed red blood cell units in the emergency trauma room; admission between 2005 and 2008; and documented data regarding intubation. The intubated patients were then matched with not-intubated patients.
  
  
  RESULTS
  The study population included 600 matched pairs that met the inclusion criteria. The results indicated that prehospital intubation was associated with a prolonged rescue time (not intubated, 64.8 minutes; intubated, 82.3 minutes; P ≤ 0.001) and a higher volume replacement (not intubated, 911.3 ml; intubated, 1,573.8 ml; P ≤ 0.001). In the intubated patients, coagulation parameters, such as the prothrombin time ratio (PT) and platelet count, declined, as did the hemoglobin value (PT not intubated: 92.3%; intubated, 85.7%; P ≤ 0.001; hemoglobin not intubated, 13.4 mg/dl; intubated, 12.2 mg/dl; P ≤ 0.001). Intubation at the scene resulted in an elevated sepsis rate (not intubated, 1.5%; intubated, 3.7%; P ≤ 0.02) and an elevated prevalence of multiorgan failure (MOF) and organ failure (OF) (OF not intubated, 9.1%; intubated, 23.4%; P ≤ 0.001).
  
  
  CONCLUSIONS
  Prehospital intubation in trauma patients is associated with a number of risks and should be critically weighed, except in cases with clear indicators, such as posttraumatic apnea.
authors.affiliation: Trauma Surgery Department, University Hospital Essen, Hufelandstraße 55, 45122 Essen, Germany. bjoern.hussmann@uk-essen.de
authors.forename: Bjoern
authors.initials: B
authors.lastname: Hussmann
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Christian
authors.initials: C
authors.lastname: Waydhas
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaisade
authors.forename: Max Daniel
authors.initials: MD
authors.lastname: Kauther
authors.forename: Sven
authors.initials: S
authors.lastname: Lendemans
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009017:Morbidity; D009102:Multiple Organ Failure / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult