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

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 self-presenters. 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 in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital 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.

Clinical trial registration

NCT02210221.

Metadata

Item Type:	Article
Authors/Creators:	Gravesteijn, BY Sewalt, CA Nieboer, D Menon, DK Maas, A Lecky, F https://orcid.org/0000-0001-6806-0921 Klimek, M Lingsma, HF Åkerlund, C Amrein, K Andelic, N Andreassen, L Anke, A Antoni, A Audibert, G Azouvi, P Azzolini, ML Bartels, R Barzó, P Beauvais, R Beer, R Bellander, B-M Belli, A Benali, H Berardino, M Beretta, L Blaabjerg, M Bragge, P Brazinova, A Brinck, V Brooker, J Brorsson, C Buki, A Bullinger, M Cabeleira, M Caccioppola, A Calappi, E Calvi, MR Cameron, P Lozano, GC Carbonara, M Cavallo, S Chevallard, G Chieregato, A Citerio, G Ceyisakar, I Clusmann, H Coburn, M Coles, J Cooper, JD Correia, M Čović, A Curry, N Czeiter, E Czosnyka, M Dahyot-Fizelier, C Dark, P Dawes, H De Keyser, V Degos, V Della Corte, F Boogert, HD Depreitere, B Đilvesi, Đ Dixit, A Donoghue, E Dreier, J Dulière, G-L Ercole, A Esser, P Ezer, E Fabricius, M Feigin, VL Foks, K Frisvold, S Furmanov, A Gagliardo, P Galanaud, D Gantner, D Gao, G George, P Ghuysen, A Giga, L Glocker, B Golubovic, J Gomez, PA Gratz, J Gravesteijn, B Grossi, F Gruen, RL Gupta, D Haagsma, JA Haitsma, I Helbok, R Helseth, E Horton, L Huijben, J Hutchinson, PJ Jacobs, B Jankowski, S Jarrett, M Jiang, J-Y Johnson, F Jones, K Karan, M Kolias, AG Kompanje, E Kondziella, D Koraropoulos, E Koskinen, L-O Kovács, N Kowark, A Lagares, A Lanyon, L Laureys, S Lecky, F Ledoux, D Lefering, R Legrand, V Lejeune, A Levi, L Lightfoot, R Lingsma, H Maas, AIR Castaño-León, AM Maegele, M Majdan, M Manara, A Manley, G Martino, C Maréchal, H Mattern, J McMahon, C Melegh, B Menon, D Menovsky, T Mikolic, A Misset, B Muraleedharan, V Murray, L Negru, A Nelson, D Newcombe, V Nieboer, D Nyirádi, J Olubukola, O Oresic, M Ortolano, F Palotie, A Parizel, PM Payen, J-F Perera, N Perlbarg, V Persona, P Peul, W Piippo-Karjalainen, A Pirinen, M Ples, H Polinder, S Pomposo, I Posti, JP Puybasset, L Radoi, A Ragauskas, A Raj, R Rambadagalla, M Rhodes, J Richardson, S Richter, S Ripatti, S Rocka, S Roe, C Roise, O Rosand, J Rosenfeld, JV Rosenlund, C Rosenthal, G Rossaint, R Rossi, S Rueckert, D Rusnák, M Sahuquillo, J Sakowitz, O Sanchez-Porras, R Sandor, J Schäfer, N Schmidt, S Schoechl, H Schoonman, G Schou, RF Schwendenwein, E Sewalt, C Skandsen, T Smielewski, P Sorinola, A Stamatakis, E Stanworth, S Stevens, R Stewart, W Steyerberg, EW Stocchetti, N Sundström, N Synnot, A Takala, R Tamás, V Tamosuitis, T Taylor, MS Ao, BT Tenovuo, O Theadom, A Thomas, M Tibboel, D Timmers, M Tolias, C Trapani, T Tudora, CM Vajkoczy, P Vallance, S Valeinis, E Vámos, Z van der Jagt, M Van der Steen, G van der Naalt, J van Dijck, JTJM van Essen, TA Van Hecke, W van Heugten, C Van Praag, D Vyvere, TV van Wijk, RPJ Vargiolu, A Vega, E Velt, K Verheyden, J Vespa, PM Vik, A Vilcinis, R Volovici, V von Steinbüchel, N Voormolen, D Vulekovic, P Wang, KKW Wiegers, E Williams, G Wilson, L Winzeck, S Wolf, S Yang, Z Ylén, P Younsi, A Zeiler, FA Zelinkova, V Ziverte, A Zoerle, T
Copyright, Publisher and Additional Information:	© 2020 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords:	effectiveness; Europe; neurological outcome; prehospital; tracheal intubation; traumatic brain injury
Dates:	Accepted: 28 May 2020 Published (online): 31 July 2020 Published: October 2020
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
Depositing User:	Symplectic Sheffield
Date Deposited:	12 Aug 2020 16:23
Last Modified:	24 Jan 2022 14:07
Status:	Published
Publisher:	Elsevier BV
Refereed:	Yes
Identification Number:	10.1016/j.bja.2020.05.067
Related URLs:	PubMed URL
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:164326

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

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