ass=""h4"">Background
The indic
ations for immedi
ate intu
bation in tr
aum
a are not controversi
al,
but some p
atients who initi
ally
appe
ar st
able l
ater deterior
ate
and require intu
bation. We postul
ated th
at initi
ally st
able, moder
ately injured tr
aum
a p
atients who experienced del
ayed intu
bation h
ave higher mort
ality th
an those intu
bated e
arlier.
ass=""h4"">Methods
Medical records of trauma patients intubated within 3 h of arrival in the emergency department at our university-based trauma center were reviewed. Moderately injured patients were defined as an ISS < 20. Early intubation was defined as patients intubated from 10?4 min of arrival. Delayed intubation was defined as patients intubated ?5 min after arrival. Patients requiring immediate intubation, within 10 min of arrival, were excluded.
ass=""h4"">Results
From February 2006 to December 2007, 279 trauma patients were intubated in the emergency department. In moderately injured patients, mortality was higher with delayed intubation than with early intubation, 11.8 % versus 1.8 % (P = 0.045). Patients with delayed intubations had greater frequency of rib fractures than their early intubation counterparts, 23.5 % versus 3.6 % (P = 0.004). Patients in the delayed intubation group had lower rates of cervical gunshot wounds than the early intubation group, 0 % versus 10.7 % (P = 0.048) and a trend toward fewer of skull fractures 2.9 % versus 16.1 % , (P = 0.054).
ass=""h4"">Conclusions
These findings suggest that delayed intubation is associated with increased mortality in moderately injured patients who are initially stable but later require intubation and can be predicted by the presence of rib fractures.