Khannistha Mahem ID The Effect of Pre-Hospital Airway Management on Moderate To Severe Injury among Traumatic Patients in Khon Kaen Hospital, Thailand

O UTLINE Background & Rational Objective Methodology Result Discussion Conclusion

B ACKGROUND & R ATIONALE WHO,2011: Important Death Accident 6.6% Non-Accident 2.5

B ACKGROUND & R ATIONALE Thailand, 2009: 28 sentinel site mostly moderate to severe injury 153,237 cases death 6,928 cases CFR 4.52% 2010 Deaths Rate by accident 51.6 /100,000 pop

B ACKGROUND & R ATIONALE EMERGENCY MEDICAL CARE: NATION INJURY SURVIELLANCE,2009

G APS OF K NOWLEDGE Rarely study on successful pre-hospital airway care association with coma scale [GCS] among traumatic patients The benefit of pre-hospital airway management in severely patients is questionable.

O BJECTIVE To investigate the effect of pre-hospital airway management on moderate to severe injury of traumatic patients in Khon Kaen hospital, Thailand. Research Question Dose the pre-hospital airway management affect to moderate to severe injury among traumatic patients?

O PERATIONAL D EFINITION Appropriated airway management Inappropriate airway management 1. Hyperventilation 2. Intubation too deep 3 Foreign body obstruction in the ET tube 4.Input oral ET tube but do not put Oral airway 5.ET tube would not fit small or cuff leak GCS Moderate to Severe= 3-12 Mild = 13-15

MATERIALS AND METHODS Study design >>> based on the cross-sectional analytical study, The secondary data, National Injury Surveillance The effect study >> pre-hospital airway care [inappropriate] Study outcome :GCS >>> consisting of 15 items motor response (6 items) verbal response (5 items) eye opening (4 items) Summed scores range from a minimum of 3 to a maximum of 15 moderate to severe injury >>>GCS scores= 3–12 mild injury>>>GCS=13–15

S TATISTICAL ANALYSIS Descriptive statistics Bivariate analysis (crude OR,95%CI,p-value) Multivariable analysis (adj OR,95%CI,p-value) potential confounders p < 0.05

R ESULTS : T ARGET P OPULATION Figure 1 Intention to traumatic patients due to accident injuries, Khon Kaen Hospital, Thailand

R ESULTS

T ABLE 2. O DDS RATIOS (OR S ) OF MODERATE TO SEVERE INJURY AND THEIR 95% CONFIDENCE INTERVALS FOR EACH FACTOR PRESENTED IN THE TABLE USING LOGISTIC REGRESSION

Table3. ORs of moderate to severe injury and their 95% confidence intervals

R ESULT Factors associated with Mortality

D ISCUSSION Consciousness level, outcomes evaluated among traumatic patients with Glasgow Coma Scale (GCS) scores  12 isolated in moderate to severe injury, there were 56.14% and 43.41% of mild injury. The finding illustrated that pre-hospital airway care were at an inappropriate care is associated with around 2 times increase in moderate to severe injury. According to the above findings, Winchell and Hoyt In contrast to this findings, Davis et al, Bukur et al Finally, pre-hospital airway management

L IMITATION OF THE STUDY Selection bias may occur from exclusion of patients from the analysis, as well as those with missing data, could have introduced bias to the results. The Instrument dose not coverage the characteristics of personal of emergency pre-hospital providers for analyze.

C ONCLUSIONS In this analysis, we were able to demonstrate a conclusive benefit of inappropriate of pre-hospital airway caring on the moderate to severe trauma patients requiring airway care after adjusting for other important factors in a propensity adjusted model. Recommendations>>Training in first aid should be available more widely Beware C-spine immobilization

Acknowledgement Trauma and Critical Care Center of Khon Kaen Hospital Assoc. Prof. Dr.Bandit Thinkamrop Assoc. Prof. Dr. Wongsa Laohasiriwong Dr. Cameron P Hurst Miss. Wilaipron Thinkamrop Miss. Jitjira Chaiyarit Mr. Kavin Thinkamrop

Thank you for your attention