Khannistha Mahem ID The Effect of Pre-Hospital Airway Management on Mortality among Unintentional Injured Patients in Khon Kaen, Thailand

Outline Background & Rational Objective Methodology Result Discussion Conclusion Slide 2

Background Airway Management Slide 3

Background (world) Deaths(1,000) in 2011 Slide 4 Un intenional Injuries

Background (Thailand) New Year Normally number/day IS;153,237, Dead 6,928 Case Fatality Rate=4.52% IS: Road Traffic Accident,Khon Kaen Slide 5 Deaths Rate Per 100,000 Population

Background (Pre-hospital care) Emergency Medical Institute crisis 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% relatve 61.19% and non registered organization 0.4%(2009) Slide 6

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 management Improperly care 2.26% No medical care but needed 5.75% * Standard setting: %not more than 5% of all injury case who need medical care Slide 7

Los Angeles study ( ) 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] Patients selected for RSI-ETI were less seriously injured, with better prognostic factors than intubated patients for whom RSI was not used. After adjusting for these differences, use of pre-hospital RSI-ETI was not associated with improved survival. Prior Studies (The pre-hospital airway management ) Slide 8

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 Slide 9

Objective To investigate the effect of pre-hospital airway management on mortality of accidental injury patients in Khon Kaen Hospital, Thailand. Research Question Dose the pre-hospital airway management affect to mortality among unintentional Injured patients? Slide 10

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 Materials and Methods Slide 11

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 Slide 12

Results 1Target Population Slide 13

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) Slide 14

2. Bivariate Analysis Slide 15

3. Multivariate analysis of all patients Slide 16

Result Factors associated with Mortality Slide 17

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) Slide 18

Discussion Theoretical principle Los Angeles study Cudnik,et al. Strength & Limitations Small sample size confounding factors bias Slide 19

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. Slide 20

Acknowledgement Trauma and Critical Care Center of Khon Kaen Hospital Assoc. Prof.Dr.Bandit Thinkamrop Mr. Kavin Thinkamrop Miss.Jitjira Chaiyarit Miss. Wilaipron Thinkamrop Slide 21

Thank you for your attention Slide 22