1. Khannistha Mahem ID 567110065 The Effect of Pre-Hospital Airway Management on Mortality among Unintentional Injured Patients in Khon Kaen, Thailand

2. Outline Background Methodology Result Discussion Conclusion Slide 2

3. Background Airway Management Slide 3

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

5. Background (Thailand) 400 300 200 100 0 New Year Normally number/day 9 4 5 11 7 292 242 258 211 279 1.29 1.57 0.57 0.71 1.00 0.78 0.82 0.71 0.70 0.59 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 2007-2012

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) Slide 6

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 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

8. 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. Prior Studies (The pre-hospital airway management ) Slide 8

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 Slide 9

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

11. Study design Cross-sectional analytical study Based on the National Injury Surveillance Records From January to December 2012 Dependent Variable: Mortality Independent Variable : Pre-hospital airway management Materials and Methods Slide 11

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 Slide 12

13. Results 1Target Population Slide 13

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%) Slide 14

15. Results Slide 15

16. Results Number of pre-hospitsl care Slide 16 Pre-hospital Care non but needed Improperly done Properly done unnecessary Airway3191,53421,461 Bleeding control 1187 (5.15%) 456,35715,446 C-spine immobilizati on 4151,98421,005 Splint13384,83518,059 IV Fluid3824,07418,921

17. Results Slide 17

18. 2. Bivariate Analysis Slide 18

19. 3. Multivariate analysis of all patients Slide 19 *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 Slide 20

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,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) Slide 21

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

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. Slide 23

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 Slide 24

25. Thank you for your attention Slide 25