title: Characterizing demographics, injury severity, and intubation status for patients transported by air or ground ambulance to a rural burn center.
abstract: Our study was designed to characterize intubation status among patients transported by air or ground ambulance to a rural burn center. A retrospective chart review of patients arriving at our burn center from January 1, 2005 to December 31, 2009 was completed. Descriptive and multivariate analyses were performed. During the study period, 259 air and 590 ground ambulance patients met inclusion criteria. Air ambulance patients were older and had higher total body surface area burned, lower Glasgow Coma scores, longer lengths of stay, and more frequent inhalation injuries. Approximately 10% of patients arriving by air were intubated after burn center admission, and 49% of intubated patients were extubated within 24 hours of admission. These values were 2% and 40%, respectively, for patients transported by ground. Increasing age and air ambulance transport increased the overall likelihood of change in intubation status. The likelihood of intubation by burn center providers increased with age, with suspicion of inhalation injury, and for patients transported by air. The likelihood of extubation within 24 hours of burn center admission increased with age, decreased with suspected inhalation injury, and was independent of transport mode. Among our patient population, more severely injured patients were being transported by air ambulance. However, age, suspicion of inhalation injury, and mode of transport showed a complex pattern of associations with changes in intubation status, and illustrate the need to develop better prehospital guidelines for intubation in burn patients.
authors.affiliation: From the Departments of *Emergency Medicine and †Surgery, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Paul
authors.initials: P
authors.lastname: Van Heukelom
authors.forename: Karisa
authors.initials: K
authors.lastname: Harland
authors.forename: Gerene
authors.initials: G
authors.lastname: Denning
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
authors.forename: Janelle
authors.initials: J
authors.lastname: Born
authors.forename: Barbara
authors.initials: B
authors.lastname: Latenser
mesh_terms: D000293:Adolescent; D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000552:Ambulances / Q000706:statistics & numerical data*; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002059:Burns, Inhalation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000379:methods*; D007484:Iowa; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D019035:Rural Health Services; D015996:Survival Rate; D014187:Transportation of Patients / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult