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The Effect of Pre-Hospital Airway Management on Mortality among
Unintentional Injured Patients in Khon Kaen, Thailand Khannistha Mahem ID
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Outline Background Methodology Result Discussion Conclusion
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Background Airway Management
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Un intentional Injuries
Background (world) Deaths(1,000) in 2011 Un intentional Injuries WHO,2011
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Background (Thailand)
IS;153,237, Dead 6,928 Case Fatality Rate=4.52% 400 300 200 1.57 292 279 242 258 1.29 211 1.00 0.78 0.71 0.82 100 0.70 0.71 0.59 0.57 New Year Normally number/day number/day Deaths Rate Per 100,000 Population IS: Road Traffic Accident ,Khon Kaen
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Background (Pre-hospital care)
Emergency Medical Institute 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)
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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
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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. Cudnik,et al. [2010] After adjusting for these differences, use of pre-hospital RSI-ETI was not associated with improved survival.
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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
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Research Question Objective
Dose the pre-hospital airway management affect to mortality among unintentional Injured patients? Objective To investigate the effect of pre-hospital airway management on mortality of unintentional Injured patientsin Khon Kaen Hospital, Thailand.
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Materials and Methods Cross-sectional analytical study Study design
Based on the National Injury Surveillance Records From January to December 2012 Dependent Variable: Pre-hospital airway management Independent Variable: Mortality
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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
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Results 1Target Population
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Demographic Characteristics
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%)
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Results
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Results Number of pre-hospitsl care Pre-hospital Care non but needed
Improperly done Properly done unnecessary Airway 31 9 1,534 21,461 Bleeding control 1187 (5.15%) 45 6,357 15,446 C-spine immobilization 41 5 1,984 21,005 Splint 133 8 4,835 18,059 IV Fluid 38 2 4,074 18,921
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Results
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2. Bivariate Analysis
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3. Multivariate analysis of all patients
*Adjust for gender, age, cause of accidents, alcohol drinking, stop bleeding, intravenous fluid and consciousness
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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
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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,et al. 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)
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Discussion Limitations Small sample size confounding factors Bias
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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.
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Acknowledgement Trauma and Critical Care Center of Khon Kaen Hospital
Assoc. Prof.Dr.Bandit Thinkamrop Mr. Kavin Thinkamrop Miss.Jitjira Chaiyarit Miss. Wilaipron Thinkamrop
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Thank you for your attention
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