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

[en] 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. © 2020 The Author(s)

Research center :

CHU de Liège-Centre du Cerveau² - ULiège

Disciplines :

Public health, health care sciences & services

Author, co-author :

Gravesteijn, B. Y.; Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, Netherlands, Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands

Sewalt, C. A.; Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands

Nieboer, D.; Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands, Department of Public Health, Erasmus Medical Center-University Medical Center, Rotterdam, Netherlands

Menon, D. K.; Department of Anaesthesiology, University of Cambridge, United Kingdom

Maas, A.; Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium

Lecky, F.; Emergency Medicine Research in Sheffield (EMRiS), School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, United Kingdom, Centre for Urgent and Emergency Care Research (CURE), Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom, Emergency Department, Salford Royal Hospital, Salford, United Kingdom

Klimek, M.; Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, Netherlands

Lingsma, H. F.; Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands

Åkerlund, C.; Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden

Amrein, K.; János Szentágothai Research Centre, University of Pécs, Pécs, Hungary

More authors (242 more)

Language :

English

Title :

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

Publication date :

2020

Journal title :

British Journal of Anaesthesia

ISSN :

0007-0912

eISSN :

1471-6771

Publisher :

Elsevier Ltd

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 07 March 2021

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