The Effect of Pre-Hospital Airway
Management on Mortality among
Unintentional Injured Patients
in Khon Kaen, Thailand
Khannistha Mahem
ID 567110065
Outline
• Background & Rational
• Objective
• Methodology
• Result
• Discussion
• Conclusion
Slide 2
Background
Airway Management
Slide 3
Background (world)
Deaths(1,000) in 2011
2.5
2.3
Un intenional Injuries
2
1.5
1.5
1.2
1
0.7
0.5
0.5
0.4
0
Intentional Injuries
2
1.5
0.9
0.2
0
Slide 4
Background (Thailand)
IS;153,237, Dead 6,928 Case Fatality Rate=4.52%
400
1.57
292
300
279
258
242
1.29
211
200
0.78
1.00
0.71
0.82
100
0.57
0 9
4
New Year
number/day
Deaths Rate Per 100,000 Population
0.71
5
0.70
11
0.59
7
Normally
number/day
IS: Road Traffic Accident ,Khon Kaen
Slide 5
Background (Pre-hospital care)
• Emergency Medical Institute 2010-2012
• crisis severity patients received the outhospital care by EMS>>>> increased & uprise in the future 82,895 times (8.73%) to
99,112 (9.75%)
• KhonKaen Province (National Injury
Surveillance) severe injury patients almost
referred to hospital by EMS 36.11% relatve
61.19% and non registered organization
0.4%(2009)
Slide 6
Background (Pre-hospital care)
• while caring to hospital by EMS
The pre-hospital airway management 43.37% no
medical care but needed
1.91% improperly care
• referred to the upper level
The pre-hospital airway management Improperly
care 2.26%
No medical care but needed 5.75%
*Standard setting: %not more than 5% of all injury case who
need medical care
Slide 7
Prior Studies
Slide 8
(The pre-hospital airway management )
• Los Angeles study (2005-2009)
• Pre-hospital endotracheal intubation in
isolated, moderate to severe TBI patients is
associated with a nearly 5-fold increase in
mortality.
• Cudnik,et al. [2010]
• Patients selected for RSI-ETI were less
seriously injured, with better prognostic
factors than intubated patients for whom RSI
was not used. After adjusting for these
differences, use of pre-hospital RSI-ETI was
not associated with improved survival.
Gabs of Knowledge
• ignored to shown the test of
association or measurement in
Thailand
• this study purpose to investigate
the effect of pre-hospital airway
management on the mortality
Slide 9
Research Question
Dose the pre-hospital airway management
affect to mortality among unintentional
Injured patients?
Objective
• To investigate the effect of pre-hospital
airway management on mortality of
accidental injury patients in Khon Kaen
Hospital, Thailand.
Slide 10
Materials and Methods
Study design
Cross-sectional analytical study
Based on the National Injury
Surveillance Records From January
to December 2012
Dependent Variable: Pre-hospital airway
management
Independent Variable: Mortality
Slide 11
Materials and Methods
Statistical analysis
Descriptive statistics
Bivariate analysis (crude OR,95%CI,p-value)
Multivariable analysis (adj OR,95%CI,p-
value)
potential confounders p < 0.05
Setting: Khon Kaen Province
Slide 12
Results 1Target Population
Total Injury Patients
(n = 25,838)
Intension Self-harm
Assault
344(1.33%)
2,443(9.46%)
Traumatic Accidental Case
At Emergency Department
23,049 (89.21%)
Emergency Department
Khon Kaen Hospital
Legal Battle
1(00.00%)
Unknown
1(0.00%)
Excluded (n =6)
-Death before arrive (1)
-Missing data on traumatic accident (5)
Assessing Pre-hospital Airway
23,043
No medical care
But needed
31 (0.13%)
Properly done
1,534 (6.66%)
Improperly done
9 (0.04%)
Unnecessary
21,461 (93.13%)
Unknown
8 (0.03%)
Receiving Pre-hospital Airway =1,574cases
Deaht at ED=51 Cases
Appropriated
1,534 Cases
Inappropriate
40 Cases
Figure 1 Intention to the Traumatic Accidental
Patients, Khon Kaen Hospital Thailand
Slide 13
Results
• 2.Demographic Characteristics
• 25,838 injury patients,
• accident (89.21%),
• assault (9.46%)
• intension self–harm (1.33%)
• 23,035 traumatic accident patients
• 64.74%, were male
• mean age of 31.86(19.54)
• labors (39.62 %), student (26.06%), agricultural,
(6.57%)
• Trauma due to transportation 43.59%,
• Trauma due to 56.40% in the others. (approve in
Slide 14
Chart)
2. Bivariate Analysis
Table 2. Odds ratios (ORs) of mortality and their 95% confidence intervals for each factor
presented in the table using logistic regression
Variable
Total
%
Crude
mortality
OR
95%CI
0.018
Gender
Female
Male
p-value
8,113
0.12
1
14,872
0.27
2.18
to 4.37
1.10
Age (years)
31.86(19.54)
1.05
0.96 to 1.14
<0.001
Cause of Injury
The Others
12,992
Transportation
Accident
0.06
1
0.42
6.82
10,042
to 14.52
3.20
0.468
Alcohol Drinking
No
19,409
Yes
0.11
1
0.16
1.46
3,176
to 3.86
0.55
0.596
Stop Bleeding
Appropriated
6,357
0.52
1
In-appropriated
1,232
0.41
0.78
4,074
0.88
1
40
10.00
12.46
1,534
2.41
1
40
12.50
5.78
0.30 to 2.00
<0.001
Intravenous Fluid
Appropriated
In-appropriated
4.11 to35.82
0.004
Clear Airway
Appropriated
In-appropriated
2.14
toto15.59
<0.001
Consciousness
Good
0.291
23,035
20,776
0.03
1
2,081
2.02
71.30
Consciousness
Unconsciousness
30.28
tt to167.93
Slide 15
3. Multivariate analysis of all patients
Variable
Total
%
Crude
Adjusted
mortality
OR
OR
95%CI
pvalue
Consciousness
0.002
Good Consciousness
20,776
0.03
1
1
Unconsciousness
2,081
2.02
71.30
12.67
1.33 to
120.90
Stop Bleeding
<0.001
Appropriated
6,357
0.52
1
1
In-appropriated
1,232
0.41
0.78
10.75
1.21to
95.32
Alcohol Drinking
<0.001
No
19,409
0.11
1
1
Yes
3,176
0.16
1.46
0.25
0.07 to
0.90
<0.001
Clear Airway
Appropriated
In-appropriated
1,534
2.41
1
1
40
12.50
5.78
3.42
0.42 to 27.91
Slide 16
Result
Factors associated with Mortality
Slide 17
Discussion
• pre-hospital inappropriate airway
management was associated with
significantly increased mortality
• (ORc 5.78, 95%CI: 2.14 to15.59; p=0.004)
• Then…..
• (ORadj 3.42 , 95% CI: 0.42 to27.91, p<
0.001)
Slide 18
Discussion
• Theoretical principle
Los Angeles study
Cudnik,et al.
• Strength & Limitations
Small sample size
confounding factors
bias
Slide 19
Conclusions
• unable to demonstrate a conclusive of
appropriate in pre-hospital airway
management on survival trauma patients in a
propensity-adjusted model.
• These finding further strength to the need for
prospective, randomized studies to identify
those patients that might achieve a survival
benefit from this procedure.
Slide 20
Acknowledgement
Trauma and Critical Care Center of Khon Kaen Hospital
Assoc. Prof.Dr.Bandit Thinkamrop
Mr. Kavin Thinkamrop
Miss.Jitjira Chaiyarit
Miss. Wilaipron Thinkamrop
Slide 21
Thank you
for your attention
Slide 22