IMPACT OF SETTING OF INJURY AND LEVEL OF TRAUMA CENTER ON TRAUMA MORTALITY AFTER FIELD INTUBATION

Abstract

Purpose: Pre-hospital intubation (PHI) in major trauma is associated with increased mortality. The goal of this study was to determine if PHI is protective in patients injured in rural vs. urban locations or patients transferred to level II vs. level I trauma centers. Methods: The Pennsylvania Trauma Outcomes Study database from 2006 - 2011 was reviewed. Pediatric patients, burns, patients dead on arrival, and transfers were excluded. Patients receiving PHI were compared to those immediately transported. Results: Of 63264 trauma patients, 2725 (4.31%) were intubated in the field. Mortality was higher among the intubated than those not intubated (28.22% vs. 4.11%, p<0.0001). The intubated cohort had greater mean Injury Severity Score (ISS) (27.77 vs.13.33, p<0.0001). Factors associated with mortality on multivariate logistic regression included PHI (OR 6.284, p<.0001), ISS>25 (OR 35.384, p<.0001), penetrating trauma (OR 5.685, p<.0001), transport to level II trauma center (OR 1.151, p=