title: Prehospital intubation does not decrease complications in the penetrating trauma patient.
abstract: Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to determine if PHI in patients with penetrating trauma results in reduced mortality and in-hospital complications. Patient records for all Category 1 trauma activations as a result of penetrating injury admitted to our institution from 2006 to 2010 were reviewed. There were 1615 Category 1 trauma activations with 152 (9.8%) intubated in the field. A total of 1311 survived initial resuscitative efforts to permit hospital admission with 55 (4.2%) being intubated in the field. For patients surviving to admission, prehospital intubation was associated with increased mortality (hazard ratio, 8.266; 95% confidence interval [CI, 4.336 to 15.758; P < 0.001). After correcting for Injury Severity Score, PHI was not protective against pulmonary complications (odds ratio [OR], 0.724; 95% CI, 0.229 to 2.289; P = 0.582), deep vein thrombosis/pulmonary embolus (OR, 0.838; 95% CI, 0.281 to 2.494; P = 0.750), sepsis (OR, 0.572; 95% CI, 0.201 to 1.633; P = 0.297), wound infections (OR, 1.739; 95% CI, 0.630 to 4.782; P = 0.286), or complications of any kind (OR, 1.020; 95% CI, 0.480 to 2.166; P = 0.959). For victims of penetrating trauma, immediate transportation by emergency medical personnel may result in improved outcomes.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Halley P
authors.initials: HP
authors.lastname: Vora
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: Abhijit S
authors.initials: AS
authors.lastname: Pathak
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Santora
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D014951:Wounds, Stab / Q000150:complications* / Q000401:mortality / Q000628:therapy*