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Impact of Pre-Hospital Airway Management on Mortality in Injured Patients

Investigating the effect of pre-hospital airway management on mortality of accidental injury patients in Khon Kaen, Thailand, based on a cross-sectional study using National Injury Surveillance records from 2012. Results show factors associated with mortality, with significant implications discussed.

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Impact of Pre-Hospital Airway Management on Mortality in Injured Patients

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  1. The Effect of Pre-Hospital Airway Management on Mortality among Unintentional Injured Patients in KhonKaen, Thailand KhannisthaMahem ID 567110065

  2. Outline • Background & Rational • Objective • Methodology • Result • Discussion • Conclusion

  3. Background & Rationale Road Traffic Accidents Death Rate Per 100,000Data; Source: WHO 2011

  4. Background & Rationale(World Wide) Causes of injuries ,2011 WHO 2011

  5. Background & Rationale(Thailand) Top 5 Caused of death,2010

  6. Background & Rationale (Khon Kaen) 12000 10000 8000 400 300 200 1.57 40.43 292 40.57 279 9823 10131 258 8715 8723 8811 242 1.29 36.29 211 28.30 33.57 27.44 1.00 6000 4000 2000 0.78 0.71 24.34 0.82 24.37 24.61 100 0.70 0.59 0.71 0.57 9 4 5 11 7 0 284 235 216 283 254 2550 2551 2552 2553 2554 Normally New Year New Year Normally number/day number/day number/day number/day

  7. Background & Rationale(Pre-hospital care) • 2010-2012crisis severity patients received the out-hospital care by EMS>>>> increased & up-rise 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% relationship 61.19% and non registered organization 0.4%

  8. Background & Rationale(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 managementImproperly care 2.26% • No medical care but needed 5.75%

  9. Prior Studies(The pre-hospital airway management ) • Los Angeles study • Pre-hospital endotracheal intubation in isolated, moderate to severe TBI patients is associated with a nearly 5-fold increase in mortality. Further prospective studies are required to establish guide- lines for optimal pre-hospital management of this critically injured patient population

  10. Prior Studies(The pre-hospital airway management ) • Cudnik,et al. [2010] • There were 877 consecutive trauma patients who had pre-hospital ETI during this period and were included in the analysis. Of these, 496 (57%) had RSI-ETI. In univariate analyses, those with RSI-ETI had less severe injuries, better pre-hospital physiology • lower unadjusted mortality than those intubated without RSI. However, in the propensity-adjusted model, there was no statistical difference in mortality between the two groups (odds ratio 0.74, 95% confidence interval 0.52–1.06)

  11. Gabs of Knowledge • ignored to shown the test of association or measurement • this study purpose to investigate the effect of pre-hospital airway management on the mortality

  12. Research Question Objective Dose the pre-hospital airway management affect to mortality among unintentional Injured patients? • To investigate the effect of pre-hospital airway management on mortality of accidental injury patients in Khon Kaen Hospital, Thailand.

  13. 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 • EC……

  14. 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

  15. Results 1Target Population

  16. 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 Chart)

  17. 2. Bivariate Analysis

  18. 3. Multivariate analysis of all patients

  19. Result • Factors associated with Mortality

  20. 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)

  21. Discussion • Theoretical principle • Los Angeles study • Cudnik,et al. • Strength & Limitations • Small sample size • confounding factors • bias

  22. 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.

  23. Acknowledgement • Trauma and Critical Care Center of Khon Kaen Hospital • Assoc. Prof.Dr.Bandit Thinkamrop • Mr. Kavin Thinkamrop • Miss.Jitjira Chaiyarit • Miss. Wilaipron Thinkamrop

  24. Thank you for your attention

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