title: Should uncooperative trauma patients with suspected head injury be intubated?
abstract: In trauma patients with a suspicion for traumatic brain injury (TBI), a head computed tomography (CT) scan is imperative. However, uncooperative patients often cannot undergo imaging without sedation and may need to be intubated. Our hypothesis was that among mildly injured trauma patients, in whom there is a suspicion of a head injury, uncooperative patients have higher rates of TBI and intubation should be considered to obtain a CT scan. We found that uncooperative patients intubated for diagnostic purposes were more likely to have moderate to severe TBI than nonintubated patients (21.4 vs. 8.4%, P < 0.0001) and uncooperative behavior leading to intubation was an independent predictor of TBI (odds ratio, 2.5; 95% confidence interval, 1.5 to 4.5). Of patients with brain injury, intubated patients more often had a head abbreviated injury scale score of 4 (20.8 vs. 7.9%, P = 0.04). Uncooperative intubated patients had longer hospital stays (3.6 vs. 2.6 days, P = 0.003) and higher mortality (0.9 vs. 0.2%, P = 0.02) than nonintubated patients. Uncooperative behavior may be an early warning sign of TBI and the trauma surgeon should consider intubating uncooperative trauma patients if there is suspicion for brain injury based on the mechanism of their trauma.
authors: UCSF–East Bay, Department of Surgery, 1411 East 31st Street, QIC 22134, 3rd Floor, Oakland, CA 94602, USA. argarcia@acmedctr.org
authors: Arturo
authors: A
authors: Garcia
authors: Louise Y
authors: LY
authors: Yeung
authors: Emily J
authors: EJ
authors: Miraflor
authors: Gregory P
authors: GP
authors: Victorino
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D016001:Confidence Intervals; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology