Prehospital intubation as a prognostic factor related to survival in polytrauma patients in Navarre: a retrospective cohort study.

Abstract

Objective: To study factors associated with prehospital orotracheal intubation and the association between intubation and survival in polytrauma patients.

Methods: Retrospective observational cohort study. Cases were entered into the Major Trauma Registry of the Spanish autonomous community of Navarre between January 1, 2010, and December 31, 2019. We analyzed associations between clinical and demographic variables and the performance of prehospital intubation and survival. Multivariate logistic regression was used with mortality adjusted by inverse probability of treatment to control forconfounding factors.

Results: Of the 1909 patients attended, responders performed prehospital orotracheal intubations in 212 patients (11.1%). Intubation was associated with more severe trauma (Injury Severity Score, 35.9 vs 25.6 for patients not intubated and New Injury Severity Score [NISS], 43.8 vs 32.3) (P .001, both scores). Survival was lower in patients who were intubated before adjustment for other factors; however, after adjustment, intubation was not significantly associated with survival. Odds ratios (OR) showed that the factors most strongly associated with poor survival were advanced age , base excess, and 2 trauma scales, as follows: age OR, 1.06 (95%CI, 1.04-1.09); base excess OR, 0.92 (95% CI, 0.86-0.98); Revised Trauma Score (RTS) OR, 0.52 (95% CI, 0.39-0.67); and NISS OR, 1.04 (95% CI, 1.02-1.06).

Conclusions: Prehospital orotracheal intubation is associated with greater injury severity but not with survival. Predictors of mortality were advanced age, base excess, and trauma severity (RTS and NISS scores).