Written by Samuel Rouleau
A retrospective study found that trauma patients who were intubated in the ED had no difference in mortality compared to those intubated in the OR on propensity-matched analysis.
TraumaRama → resuscitate then intubate!
A prior study found higher mortality for trauma patients needing hemorrhage control surgery when intubated in the ED vs. OR, but this study had some issues. This propensity-matched retrospective cohort study of the Israeli National Trauma registry examined patients 18-65 requiring trauma surgery for hemorrhage control or intracranial injury within 1 hr of arrival with an Injury Severity Score ≥ 16. The primary outcome was in-hospital mortality; the secondary outcome was ICU admission.
Out of 975 patients, 861 were male, and the median age was 29; motor vehicle accidents (32.1%) and gunshot wounds (31.5%) were the most common mechanisms. The 470 patients (48.2%) who were intubated in the ED had higher ISS, rates of shock, and rates of head injury. Regression analysis without controlling for any variables found that intubation in the ED was associated with in-hospital mortality (OR 3.13; 95%CI 2.15-4.62), which is unsurprising, since patients intubated in the ED were sicker. After 1:1 propensity matching 271 patients intubated in the ED with 271 patients intubated in the OR, the rates of in-hospital mortality were similar, 12.5% vs. 12.2%, showing no association with location of intubation and in-hospital mortality. ED intubation was associated with ICU admission in the propensity-matched analysis (OR 2.52; 95%CI 1.65–3.92).
How does this change my practice?
This study shows that location of intubation for trauma patients does not predict mortality when adjusted for severity. Importantly, the patients in this cohort who were intubated in the ED were aggressively resuscitated prior to intubation. I will continue my practice of resuscitation before intubating trauma patients when feasible.
Source
Intubation Setting and Mortality in Trauma Patients Undergoing Hemorrhage Control Surgery: A Propensity Score-Matched Analysis. Anesth Analg. 2025 May 16. doi: 10.1213/ANE.0000000000007542. Epub ahead of print. PMID: 40378073
