Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.

Title

Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.

Creator

Muakkassa FF; Marley RA; Workman MC; Salvator AE

Publisher

Journal of Trauma

Date

2010
2010-06

Description

BACKGROUND:: The purpose of this study was to determine whether trauma patients who are intubated because of combativeness, and not because of medical necessity, have more complications resulting in longer lengths of stay. METHODS:: Data were retrospectively collected from 2001 through 2004 on trauma patients who were intubated because of combative behavior before hospital admission (group 1, N = 34). Cases were matched 1:2 by age, sex, injury severity score (ISS), and injury to controls each who were not intubated (group 2, N = 68). Additionally, there were 187 patients identified who were intubated because of medical necessity before hospital admission; these represented unmatched intubated controls and were divided based on ISS \textless15 (group 3, N = 58) and ISS \textgreater15 (group 4, N = 129). RESULTS:: There were no significant differences between groups 1, 2, and 3 with regard to age, sex, or ISS. There was no significant difference between the groups 1 and 2 in frequency of head injuries as demonstrated by positive computed tomography (50 vs. 37%, p = 0.28); however, there was a significant difference in frequency of neurologic deficit at discharge (33 vs. 6%, p = 0.006). There was a significant difference in the frequency of head injuries between groups 1 and 3 (50 vs. 22%, p = 0.006); however, there was no significant difference in neurologic deficit at discharge (33 vs. 22%, p = 0.24). There was a significant difference in hospital length of stay between groups 1 and 2 (7.4 +/- 5.9 vs. 4.3 +/- 4.5 days, p = 0.0009). The incidence of pneumonia was significantly greater in group 1 than in group 2 (29 vs. 0%, p \textless 0.0001). The amount of lorazepam in average mg per day was also significantly greater in group 1 versus group 2 (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p \textless 0.0001). There was also a difference in the discharge status, with significantly fewer group 1 cases being discharged home compared with group 2 (56 vs. 91%, p \textless 0.0001). There was no significant difference between groups 1 and 3 with regard to length of stay, ventilator days, pneumonia, or discharge status. There was a significant difference between groups 1 and 3 in the amount of lorazepam per day (4.4 +/- 11.5 vs. 0.4 +/- 1.6, p = 0.002). CONCLUSION:: The results from this study indicate that trauma patients who are intubated because of combativeness, and not because of medical necessity, have longer lengths of stay, increased incidence of pneumonia, and poorer discharge status when compared with matched controls. The outcomes of this group are similar to that of patients who are intubated because of medical necessity.

Subject

Adult; Female; Male; Ohio; Incidence; Intubation; Human; Chi Square Test; Case Control Studies; Retrospective Design; Violence; Physical; Restraint; Intratracheal; Treatment Outcomes; Nonparametric Statistics; Trauma Severity Indices; Length of Stay – Statistics and Numerical Data; Wounds and Injuries – Complications; Hypnotics and Sedatives – Therapeutic Use; Lorazepam – Therapeutic Use; Patient Discharge – Statistics and Numerical Data; Pneumonia – Epidemiology

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

1305–1309

Issue

6

Volume

68

Citation

Muakkassa FF; Marley RA; Workman MC; Salvator AE, “Hospital outcomes and disposition of trauma patients who are intubated because of combativeness.,” NEOMED Bibliography Database, accessed March 5, 2021, https://neomed.omeka.net/items/show/6017.

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