Variation in the practice of tracheal intubation in Europe after traumatic brain injury : a prospective cohort study

Abstract

Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubationpractice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injuryincluded in the prospective cohort study collaborative European neurotrauma effectiveness research intraumatic brain injury (CENTER-TBI) in 45 centres in 16 European countries. We included patients who weretransported to hospital by emergency medical services. We used mixed-effects multinomial regression toquantify the effects on pre-hospital or in-hospital tracheal intubation of the following: patient characteristics;injury characteristics; centre; and trauma system characteristics. A total of 3843 patients were included. Ofthese, 1322 (34%) had their tracheas intubated; 839 (22%) pre-hospital and 483 (13%) in-hospital. Thefit of themodel with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). The probability oftracheal intubation increased with the following: younger age; lower pre-hospital or emergency departmentGCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviatedinjury score); and one or more unreactive pupils. The adjusted median odds ratio for intubation between tworandomly chosen centres was 3.1 (95%CI 2.1–4.3) for pre-hospital intubation, and 2.7 (95%CI 1.9–3.5) for in-hospital intubation. Furthermore, the presence of an anaesthetist was independently associated with more pre-hospital intubation (OR 2.9, 95%CI 1.3–6.6), in contrast to the presence of ambulance personnel who areallowed to intubate (OR 0.5, 95%CI 0.3–0.8). In conclusion, patient and injury characteristics are key drivers oftracheal intubation. Between-centre differences were also substantial. Further studies are needed to improvethe evidence base supporting recommendations for tracheal intubation.

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Item Type:	Article
Authors/Creators:	Gravesteijn, BY Sewalt, CA Ercole, A Lecky, F Menon, D Steyerberg, EW Maas, AIR Lingsma, HF Klimek, M Åkerlund, C Adams, H Amrein, K Andelic, N Andreassen, L Anke, A Audibert, G Azouvi, P Azzolini, M Bartels, R Beer, R Bellander, B Benali, H Berardino, M Beretta, L Blaabjerg, M Borgen, L Brorsson, C Buki, A Cabeleira, M Caccioppola, A Calappi, E Calvi, M Cameron, P Carbayo, L Carbonara, M León, A Chevallard, G Chieregato, A Citerio, G Coburn, M Coles, J Cooper, J Correia, M Cnossen, M Czeiter, E Czosnyka, M Fizelier, C De Keyser, V Degos, V Della Corte, F Boogert, H Depreitere, B Dilvesi, D Dixit, A Donoghue, E Dreier, J Dulière, G Ercole Ari, A Ezer, E Fabricius, M Foks, K Frisvold, S Furmanov, A Galanaud, D Gantner, D Ghuysen, A Giga, L Golubovic, J Gomez, P Grossi, F Gupta, D Haitsma, I Helbok, R Helseth, E Hutchinson, P Jankowski, S Karan, M Kolias, A Kondziella, D Koskinen, L Kovács, N Lagares, A Laureys, S Lightfoot, R Lingsma, H Maas, A Manara, A Martino, C Maréchal, H Mattern, J McFadyen, C McMahon, C Menovsky, T Mulazzi, D Muraleedharan, V Murray, L Nair, N Negru, A Nelson, D Newcombe, V Noirhomme, Q Nyirádi, J Ortolano, F Payen, J Perlbarg, V Persona, P Peul, W Piippo‐Karjalainen, A Ples, H Pomposo, I Posti, J Puybasset, L Radoi, A Ragauskas, A Raj, R Rhodes, J Richter, S Rocka, S Roe, C Roise, O Rosenfeld, J Rosenlund, C Rosenthal, G Rossaint, R Rossi, S Sahuquillo, J Sandro, O Sakowitz, O Porras, R Schirmer‐Mikalsen, K Schou Rico, F Smielewski, P Sorinola, A Stamatakis, E Kowalk, A Steyerberg, E Stocchetti, N Sundström, N Takala, R Tamás, V Tamosuitis, T Tenovuo, O Thomas, M Tibboel, D Tolias, C Trapani, T Tudora, C Vajkoczy, P Vallance, S Valeinis, E Vámos, Z Van der Steen, G van Dijck, J Essen, T Vanhaudenhuyse, A Wijk, R Vargiolu, A Vega, E Vik, A Vilcinis, R Volovici, V Voormolen, D Vulekovic, P Williams, G Wolf, S Younsi, A Zeiler, F Ziverte, A Zoerle, T
Copyright, Publisher and Additional Information:	© 2019 The Authors. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Keywords:	Europe; guideline; practice variation; tracheal intubation; traumatic brain injury
Dates:	Accepted: 12 August 2019 Published (online): 13 September 2019 Published: 3 December 2019
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research
Funding Information:	Funder Grant number EUROPEAN COMMISSION - FP6/FP7 HEALTH-F2-2013-602150
Depositing User:	Symplectic Sheffield
Date Deposited:	30 Oct 2019 10:29
Last Modified:	19 Dec 2021 04:14
Status:	Published
Publisher:	Wiley
Refereed:	Yes
Identification Number:	10.1111/anae.14838
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:152625

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Variation in the practice of tracheal intubation in Europe after traumatic brain injury : a prospective cohort study

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