Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores <9
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Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores <9. / Emami, Pedram; Czorlich, Patrick; Fritzsche, Friederike S; Westphal, Manfred; Rueger, Johannes M; Lefering, Rolf; Hoffmann, Michael; TraumaRegister DGU.
in: EUR J TRAUMA EMERG S, Jahrgang 45, Nr. 5, 10.2019, S. 769-776.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores <9
AU - Emami, Pedram
AU - Czorlich, Patrick
AU - Fritzsche, Friederike S
AU - Westphal, Manfred
AU - Rueger, Johannes M
AU - Lefering, Rolf
AU - Hoffmann, Michael
AU - Trauma Register DGU
PY - 2019/10
Y1 - 2019/10
N2 - PURPOSE: A Glasgow Coma Scale (GCS) score of 8 or less in patients suffering from severe traumatic brain injury (TBI) represents a decision-making marker in terms of intubation. This study evaluated the impact of prehospital intubation on the mortality of these TBI cases among different age groups.METHODS: This study included the data from patients predominantly suffering from severe TBI [Abbreviated Injury Scale (AIS) of the head ≥ 3, GCS score < 9, Injury Severity Score (ISS) > 9] who were registered in TraumaRegister DGU® from 2002 to 2013. An age-related analysis of five subgroups was performed (1-6, 7-15, 16-55, 56-79, and ≥ 80 years old). The observed and expected mortality were matched according to the Revised Injury Severity Classification, version II.RESULTS: A total of 21,242 patients were included. More often, the intubated patients were severely injured when compared to the non-intubated patients (median ISS 29, IQR 22-41 vs. 24, IQR 16-29, respectively), with an associated higher mortality (42.2% vs. 30.0%, respectively). When compared to the calculated expected mortality, the observed mortality was significantly higher among the intubated patients within the youngest subgroup (42.2% vs. 33.4%, respectively; p = 0.03).CONCLUSIONS: The observed mortality in the intubated children 1-6 years old suffering from severe TBI seemed to be higher than expected. Whether or not a GCS score of 8 or less is the only reliable criterion for intubation in this age group should be investigated in further trials.
AB - PURPOSE: A Glasgow Coma Scale (GCS) score of 8 or less in patients suffering from severe traumatic brain injury (TBI) represents a decision-making marker in terms of intubation. This study evaluated the impact of prehospital intubation on the mortality of these TBI cases among different age groups.METHODS: This study included the data from patients predominantly suffering from severe TBI [Abbreviated Injury Scale (AIS) of the head ≥ 3, GCS score < 9, Injury Severity Score (ISS) > 9] who were registered in TraumaRegister DGU® from 2002 to 2013. An age-related analysis of five subgroups was performed (1-6, 7-15, 16-55, 56-79, and ≥ 80 years old). The observed and expected mortality were matched according to the Revised Injury Severity Classification, version II.RESULTS: A total of 21,242 patients were included. More often, the intubated patients were severely injured when compared to the non-intubated patients (median ISS 29, IQR 22-41 vs. 24, IQR 16-29, respectively), with an associated higher mortality (42.2% vs. 30.0%, respectively). When compared to the calculated expected mortality, the observed mortality was significantly higher among the intubated patients within the youngest subgroup (42.2% vs. 33.4%, respectively; p = 0.03).CONCLUSIONS: The observed mortality in the intubated children 1-6 years old suffering from severe TBI seemed to be higher than expected. Whether or not a GCS score of 8 or less is the only reliable criterion for intubation in this age group should be investigated in further trials.
U2 - 10.1007/s00068-018-01065-2
DO - 10.1007/s00068-018-01065-2
M3 - SCORING: Journal article
C2 - 30631886
VL - 45
SP - 769
EP - 776
JO - EUR J TRAUMA EMERG S
JF - EUR J TRAUMA EMERG S
SN - 1863-9933
IS - 5
ER -