Isolated traumatic brain injury: Routine intubation for Glasgow Coma Scale 7 or 8 may be harmful!

被引:12
作者
Jakob, Dominik A. [1 ]
Lewis, Meghan [1 ]
Benjamin, Elizabeth R. [1 ]
Demetriades, Demetrios [1 ]
机构
[1] Univ Southern Calif, Los Angeles Cty Univ Southern Calif Med Ctr, Dept Surg, Div Trauma & Surg Crit Care, Los Angeles, CA USA
关键词
Intubation; traumatic brain injury; GCS; 7; 8; MORTALITY; ETHANOL; ALCOHOL; ASSOCIATION; MANAGEMENT; OUTCOMES;
D O I
10.1097/TA.0000000000003123
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
INTRODUCTION Despite strong recommendations, there is no direct evidence supporting routine intubation of trauma patients with Glasgow Coma Scale (GCS) score of 7 or 8. We hypothesized that routine intubation may not be beneficial in isolated blunt head injury. METHODS A retrospective Trauma Quality Improvement Program study, including adult blunt trauma patients with GCS score of 7 or 8 and isolated head injury, was performed. Epidemiological and clinical characteristics, neurosurgical procedures, timing of intubation, and outcome variables were collected. The study population was stratified by the intubation procedure: immediate intubation (<= 1 hour of admission), delayed intubation (>1 hour of admission), and no intubation. Multivariable regression analysis was used to determine risk factors for mortality and complications, as well as factors predictive of the decision to intubate. RESULTS Of 2,727 patients with GCS score of 7 or 8 and isolated blunt head trauma, 1,866 patients (68.4%) were intubated within 1 hour of admission (immediate intubation), 223 (8.2%) had an intubation >1 hour of admission (delayed intubation), and 638 patients (23.4%) were not intubated at all. After correcting for age, sex, overall comorbidities, tachycardia, GCS, alcohol, illegal drug use, and head injury severity, immediate intubation was independently associated with higher mortality (odds ratio, 1.79; 95% confidence interval, 1.31-2.44; p < 0.001) and more overall complications (odds ratio, 2.46; 95% confidence interval, 1.62-3.73; p < 0.001). Increasing head Abbreviated Injury Scale (AIS) score, GCS score of 7, and tachycardia were identified as independent clinical factors associated with the decision to intubate. A policy of intubating all isolated blunt head injury patients 45 years or younger with head AIS score of 5 and GCS score of 7 would have improved intubation management, with seven immediate instead of delayed intubations and only three potentially unnecessary intubations. CONCLUSION In patients with GCS score of 7 or 8 and isolated head injury, immediate intubation was associated with higher mortality and more overall complications. Intubation management could have been improved by intubating all patients younger than 45 years with head AIS score of 5 and a GCS score of 7 on admission.
引用
收藏
页码:874 / 879
页数:6
相关论文
共 50 条
  • [31] Application and Clinical Utility of the Glasgow Coma Scale Over Time: A Study Employing the NIDRR Traumatic Brain Injury Model Systems Database
    Barker, Marie D.
    Whyte, John
    Pretz, Christopher R.
    Sherer, Mark
    Temkin, Nancy
    Hammond, Flora M.
    Saad, Zabedah
    Novack, Thomas
    JOURNAL OF HEAD TRAUMA REHABILITATION, 2014, 29 (05) : 400 - 406
  • [32] Predicting Outcomes in Traumatic Brain Injury Using the Glasgow Coma Scale: A Joint Modeling of Longitudinal Measurements and Time to Event
    Gilani, Neda
    Kazemnejad, Anoshirvan
    Zayeri, Farid
    Jafarabadi, Mohammad Asghari
    Avanji, Fatemeh Sadat Izadi
    IRANIAN RED CRESCENT MEDICAL JOURNAL, 2017, 19 (02)
  • [33] Comparing Model Performance for Survival Prediction Using Total Glasgow Coma Scale and Its Components in Traumatic Brain Injury
    Lesko, Mehdi Moazzez
    Jenks, Tom
    O'Brien, Sara J.
    Childs, Charmaine
    Bouamra, Omar
    Woodford, Maralyn
    Lecky, Fiona
    JOURNAL OF NEUROTRAUMA, 2013, 30 (01) : 17 - 22
  • [34] Diagnostic Value of the Glasgow Coma Scale for Traumatic Brain Injury in 18,002 Patients with Severe Multiple Injuries
    Grote, Stefan
    Boecker, Wolfgang
    Mutschler, Wolf
    Bouillon, Bertil
    Lefering, Rolf
    JOURNAL OF NEUROTRAUMA, 2011, 28 (04) : 527 - 534
  • [35] The Association of Glasgow Coma Scale Score With Clinically Important Traumatic Brain Injuries in Children
    Johnson, M. Austin
    Nishijima, Daniel K.
    Kuppermann, Nathan
    PEDIATRIC EMERGENCY CARE, 2020, 36 (11) : E610 - E613
  • [36] Correlation between Glasgow coma scale and Jugular venous oxygen saturation in severe traumatic brain injury
    Sharf, Mohammed Samy
    El-Gebali, Mohammed A.
    EGYPTIAN JOURNAL OF ANAESTHESIA, 2013, 29 (03): : 267 - 272
  • [37] Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention
    Ashkenazi, Itamar
    Schecter, William P.
    Peleg, Kobi
    Givon, Adi
    Olsha, Oded
    Turegano-Fuentes, Fernando
    Alfici, Ricardo
    JAMA SURGERY, 2016, 151 (10) : 954 - 958
  • [38] Role of Computed Tomography in Pediatric Traumatic Brain Injury and its Correlation with Glasgow Coma Scale at Presentation
    Imran, Ahmad
    Qureshi, Abid Ali
    Tariq, Amna
    ANNALS OF KING EDWARD MEDICAL UNIVERSITY LAHORE PAKISTAN, 2016, 22 (03): : 232 - 236
  • [39] The relation between Glasgow Coma Scale score and later cerebral atrophy in paediatric traumatic brain injury
    Ghosh, Alokananda
    Wilde, Elisabeth A.
    Hunter, Jill V.
    Bigler, Erin D.
    Chu, Zili
    Li, Xiaoqi
    Vasquez, Ana C.
    Menefee, Deleene
    Yallampalli, Ragini
    Levin, Harvey S.
    BRAIN INJURY, 2009, 23 (03) : 228 - 233
  • [40] Identifying Posttraumatic Amnesia in Individuals With a Glasgow Coma Scale of 15 After Mild Traumatic Brain Injury
    Meares, Susanne
    Shores, E. Arthur
    Smyth, Tracy
    Batchelor, Jennifer
    Murphy, Margaret
    Vukasovic, Matthew
    ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 2015, 96 (05): : 956 - 959