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首页> 外文期刊>Prehospital emergency care >Distance impacts mortality in trauma patients with an intubation attempt.
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Distance impacts mortality in trauma patients with an intubation attempt.

机译：距离会影响尝试插管的创伤患者的死亡率。

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OBJECTIVE: Out-of-hospital endotracheal intubation (OOH-ETI) has been associated with adverse outcomes; whether transport distance changes this relationship is unclear. We sought to determine whether patients injured farther from the hospital benefit more from OOH-ETI than those injured closer. METHODS: We performed a retrospective cohort analysis of trauma patients > 14 years old transported to two Level 1 trauma centers and surviving to admission from 2000 to 2003. We used probabilistically linked geographic data to calculate transport distance. To adjust for the nonrandom selection of patients for OOH-ETI, we used a propensity score based on clinical variables: prehospital physiology, demographics, transport mode, mechanism, comorbidities, Abbreviated Injury Scale head injury score >or= 3, Injury Severity Score, blood transfusion, and major surgery. Propensity-adjusted multivariable logistic regression with mode of transport was used to test the interaction between distance and OOH-ETI. RESULTS: 8,786 patients were included, 534 with OOH-ETI. Patients with OOH-ETI had higher adjusted mortality (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.33-3.18), and there was a significant interaction between distance and OOH-ETI (p = 0.02). Patients with shortest distances had the highest mortality (OR 3.98, 95% CI 2.08-7.60). Probability of mortality was higher with OOH-ETI across all distances and increased for patients closest to the hospital. Helicopter transport was associated with improved survival. CONCLUSIONS: Prehospital intubation is associated with increased mortality among trauma patients at all distances from the hospital. Patients with the shortest transport distances had the greatest mortality associated with OOH-ETI, whereas helicopter transport was associated with improved survival. The event location and ensuing distance to the hospital are another factor to consider when instituting and modifying OOH airway protocols.
机译：目的：院外气管插管（OOH-ETI）与不良预后相关。运输距离是否改变这种关系尚不清楚。我们试图确定离医院较远的患者比离医院较近的患者从OOH-ETI中受益更多。方法：我们对年龄≥14岁的创伤患者进行了回顾性队列分析，这些患者被转运到两个1级创伤中心并在2000年至2003年存活到入院。我们使用概率关联的地理数据来计算转运距离。为了适应针对OOH-ETI的患者的非随机选择，我们基于临床变量使用了倾向评分：院前生理，人口统计学，运输方式，机制，合并症，缩写伤害量表头部损伤评分>或= 3，伤害严重度评分，输血和大手术。带有运输方式的经倾向调整的多变量logistic回归用于检验距离与OOH-ETI之间的相互作用。结果：纳入了8,786例患者，其中534例患有OOH-ETI。 OOH-ETI患者的调整死亡率较高（优势比[OR]为2.06，95％置信区间[CI] 1.33-3.18），并且距离与OOH-ETI之间存在显着的相互作用（p = 0.02）。距离最短的患者死亡率最高（OR 3.98，95％CI 2.08-7.60）。 OOH-ETI在所有距离上的死亡率均较高，而离医院最近的患者的死亡率更高。直升机运输与提高生存率有关。结论：院前插管与离医院所有距离的创伤患者的死亡率增加有关。运输距离最短的患者与OOH-ETI相关的死亡率最高，而直升机运输与存活率提高相关。事件位置和与医院的距离是在制定和修改OOH气道协议时要考虑的另一个因素。

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