A Comparison of Advanced Airway Trauma Patients: Pre-Hospital vs Upon Admission

Abstract

Background:

The Glasgow coma scale (GCS) is a neurological assessment that is used to evaluate level of consciousness. A patient’s GCS score is taken into consideration when deciding whether placement of an advanced airway occurs. We aimed to evaluate and describe intubation rates among trauma patients based upon their GCS at the scene as well as the associated outcomes.

Methods:

IRB approval was obtained for this retrospective chart review of subjects who presented to a level one trauma center in south central Pennsylvania from January through December 2021. Subjects with an artificial airway placed pre-hospital or upon admission to the ED/trauma bay were included. Data was queried from the trauma registry using ICD-10 codes that signify placement of an airway. Missing or incomplete data was manually abstracted from the electronic health record. IBM SPSS software v25 (IBM, Armonk, New York) was used for data analysis.

Results:

There were 157 trauma activations in which the subject received an advanced airway. Of the 95 subjects who met inclusion criteria, 8 (8.4%) were intubated pre-hospital and 87 (91.6%) were intubated upon admission. Subjects intubated pre-hospital had a median scene GCS score of 8 (IQR = 6, 12), while those intubated upon admission had a median scene GCS score of 10 (IQR = 3.75, 15). Median hospital length of stay (LOS), ICU LOS, and ventilator days for the pre-hospital group was 3 (IQR = 0.5, 19), 2 (IQR = 0.25, 12.5), and 1 (IQR = 0.25, 6.5), respectively. Subjects intubated upon admission had LOS, ICU LOS, and ventilator days of 5 (IQR = 1, 15), 2 (IQR = 0, 7), and 1 (IQR = 0, 5). Six (75%) subjects within the pre-hospital group and 55 (63.2%) within the upon admission group were discharged alive. Results of independent samples Mann-Whitney U tests showed no statistically significant difference in LOS (P = .96), ICU LOS (P = .89), or ventilator days (P = .95) between subjects intubated pre-hospital versus upon admission. A Fishers exact test (P = .71) showed no significant difference in rates of in-hospital mortality between groups.

Conclusions:

Lower median on-scene GCS scores resulted in quicker advanced airway placement. There were no differences in mortality, LOS, ICU LOS, or ventilator days regardless of airway placement location. A larger study would be beneficial, as the smaller sample size may not have allowed for differences between groups to be detected statistically. We will continue to monitor factors and outcomes of intubation as part of our institution's trauma performance improvement program.