NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 8 - Head injury managementThe patients who required prehospital intubation mightwell have been more severely injured (hence the need foradvanced airway intervention). Table 68 shows outcome dataat 72 hours post injury in the head injured patients.Table 68. Outcome at 72 hours by intubation in theprehospital phaseNotintubatedIntubatedFailedattempt% % %Alive 225 84.9 30 62.5 1 14.3Deceased 40 15.1 18 37.5 6 85.7Total 265 48 7The intubated group had a higher mortality than the nonintubatedgroup (37.5% v 15.1%). The failed intubation grouphad a mortality rate of 85.7%. Although these are very smallnumbers this group had a much worse outcome.Airway intervention and Glasgow Coma ScoreFigure 33 and table 69 relate airway intervention toprehospital assessment of conscious level. The greater thedegree of neurological injury, the greater the likelihood of theneed for intubation. All but two of the patients who had afailed intubation attempt had a GCS of 3.Table 69. AVPU score by intubationNotintubatedIntubatedFailedattemptAlert 0 0 0Verbal 0 0 0Pain 8 4 1Unresponsive 13 7 0Total 21 11 1Tables 70 and 71 show advisors’ assessment of prehospitalairway and ventilation management. In the opinion of theadvisors, all measures were taken to secure an adequateairway in 234/273 cases and all measures to ensureFigure 33. Prehospital Glasgow Coma Score and intubation for the head injury group50454035Not intubatedIntubatedfailed attemptNumber of patients30252015105015 14 13 12 11 10 09 08 07 06 05 04 03GCS/AVPU88