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Khannistha Mahem ID 567110065

The Effect of Pre-Hospital Airway Management on Mortality among Unintentional Injured Patients in Khon Kaen , Thailand. Khannistha Mahem ID 567110065. Outline. Background Methodology Result Discussion Conclusion. Background. Airway Management. Deaths ( 1,000 ) in 2011.

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Khannistha Mahem ID 567110065

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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 • Methodology • Result • Discussion • Conclusion

  3. Background Airway Management

  4. Deaths(1,000) in 2011 Background (world) Un intentional Injuries WHO,2011

  5. Background (Thailand) IS;153,237, Dead 6,928 Case Fatality Rate=4.52% 400 300 200 1.57 292 279 258 242 1.29 211 1.00 0.78 0.71 0.82 100 0.70 0.59 0.71 0.57 9 4 5 11 7 0 2007-2012 Normally New Year number/day number/day IS: Road Traffic Accident ,Khon Kaen Deaths Rate Per 100,000 Population

  6. Background (Pre-hospital care) • Emergency Medical Institute 2010-2012 • 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 (Injury Surveillance :IS) severe injury patients almost referred to hospital by EMS 36.11% relatve 61.19% and non registered organization 0.4%(2009)

  7. Background (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% • *Standard setting: %not more than 5% of all injury case who need medical care

  8. Prior Studies(The pre-hospital airway management ) • Los Angeles study (2005-2009) • Pre-hospital endotracheal intubation in isolated, moderate to severe TBI patients is associated with a nearly 5-fold increase in mortality. • Cudnik,et al. [2010] • After adjusting for these differences, use of pre-hospital RSI-ETI was not associated with improved survival.

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

  10. 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 unintentional Injured patientsin Khon Kaen Hospital, Thailand.

  11. 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

  12. 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

  13. Results 1Target Population

  14. Results • Demographic Characteristics • Gender: 64.74%, were male • Age: mean age of 31.86(19.54) • Ranged 0-99 years • Occupation: • labors (39.62 %) • student (26.06%) • agricultural (6.57%)

  15. Results

  16. Results • Number of pre-hospitsl care

  17. Results

  18. 2. Bivariate Analysis

  19. 3. Multivariate analysis of all patients *Adjust for gender, age, cause of accidents, alcohol drinking, stop bleeding, intravenous fluid and consciousness

  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) • Relative • Eyewitness • EMS • Non registered organization • Different skill

  21. Discussion • Then….. • (ORadj 3.42 , 95% CI: 0.42 to27.91, p< 0.001) • Los Angeles study • After adjusting for possible confounding factors, multivariable logistic regression analysis demonstrated that PHI was independently associated with increased mortality (AOR 5, 95% CI: 1.7–13.7, P • (0.004) • Cudnik,etal. • 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)

  22. Discussion • Limitations • Small sample size • confounding factors • Bias

  23. 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.

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

  25. Thank you for your attention

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