Tracheal intubation in traumatic brain injury: a multicentre prospective observational study

CENTER-TBI Collaborators, Benjamin Yael Gravesteijn*, Charlie Aletta Sewalt, Daan Nieboer, David Krishna Menon, Andrew Maas, Fiona Lecky, Markus Klimek, Hester Floor Lingsma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity.

Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded selfpresenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests.

Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79-1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65-1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas inhospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): inhospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower.

Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting.

Original languageEnglish
Pages (from-to)505-517
Number of pages13
JournalBritish Journal of Anaesthesia
Volume125
Issue number4
DOIs
Publication statusPublished - Oct-2020

Keywords

  • effectiveness
  • Europe
  • neurological outcome
  • prehospital
  • tracheal intubation
  • traumatic brain injury
  • PREHOSPITAL ENDOTRACHEAL INTUBATION
  • POSITIVE-PRESSURE VENTILATION
  • RAPID-SEQUENCE INTUBATION
  • DECREASED SURVIVAL
  • HEAD-INJURY
  • CENTER-TBI
  • HYPOTENSION
  • GUIDELINES
  • MANAGEMENT
  • OUTCOMES

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