title: Prehospital non-drug assisted intubation for adult trauma patients with a Glasgow Coma Score less than 9.
abstract: OBJECTIVE
  Prehospital airway management for adult trauma patients remains controversial. We sought to review the frequency that paramedic non-drug assisted intubation or attempted intubation is performed for trauma patients in Ontario, Canada, and determine its association with mortality.
  
  
  METHODS
  We conducted a retrospective cohort study using the Ontario Trauma Registry's Comprehensive Data Set for 2002-2009. Eligible patients were greater than 16 years of age, had an initial Glasgow Coma Score of less than 9 and were cared for by ground-based non-critical care paramedics. The primary outcome was mortality. Outcomes were compared between patients undergoing prehospital intubation versus basic airway management. Logistic regression analyses were used to quantify the association between prehospital intubation and mortality.
  
  
  RESULTS
  Of the 2229 patients included in the analysis, 671 (30.1%) underwent prehospital intubation. Annual rates of prehospital intubation declined from 33.7% to 14.0% (ptrend<0.0001) over the study period. Unadjusted death rates were 66.0% versus 34.8% in the intubation and basic airway groups, respectively (p<0.0001). Intubation in the prehospital setting was associated with a heightened risk of mortality (adjusted OR 2.8, 95% CI 1.1 to 7.6).
  
  
  CONCLUSIONS
  Prehospital non-drug assisted intubation for trauma is being performed less frequently in Ontario, Canada. Within our study population, paramedic non-drug assisted intubation or attempted intubation was associated with a heightened risk of mortality.
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston General Hospital and Hotel Dieu Hospital, , Kingston, Ontario, Canada.
authors.forename: Christopher Charles Douglas
authors.initials: CC
authors.lastname: Evans
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brison
authors.forename: Daniel
authors.initials: D
authors.lastname: Howes
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.forename: William
authors.initials: W
authors.lastname: Pickett
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000639:trends; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: Trauma; emergency ambulance systems, effectiveness; emergency ambulance systems, systems; emergency care systems, emergency departments