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dc.contributor.authorFouche, Pieter Francsois
dc.contributor.authorJennings, Paul Andrew
dc.contributor.authorSmith, Karen
dc.contributor.authorBoyle, Malcolm
dc.contributor.authorBlecher, Gabriel
dc.contributor.authorKnott, Jonathan
dc.contributor.authorRaji, Mani
dc.contributor.authorRosengarten, Pamela
dc.contributor.authorAugello, Michael Roberto
dc.contributor.authorBernard, Stephen
dc.date.accessioned2018-04-11T01:31:01Z
dc.date.available2018-04-11T01:31:01Z
dc.date.issued2017
dc.identifier.issn1090-3127
dc.identifier.doi10.1080/10903127.2017.1325952
dc.identifier.urihttp://hdl.handle.net/10072/372822
dc.description.abstractIntroduction: Rapid sequence intubation (RSI) is not only used in traumatic brain injuries in the out-of-hospital setting, but also for non-traumatic brain pathologies (NTBP) such as brain tumors, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumors, aneurysms, brain hemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions, and alcohol and drug overdose. Previous research suggests that RSI is common in non-traumatic coma, but with an unknown prevalence of NTBP in those that receive RSI. If NTBP is common and if brain trauma RSI evidence is not valid for NTBP then a sizable proportion of NTBP receive this treatment without evidence of benefit. This study calculated the out-of-hospital NTBP prevalence in patients that had received RSI and explored factors that predicted survival. Methods: A retrospective cohort study based on data collected from an ambulance service and seven hospitals based in Melbourne, Australia. Non-traumatic brain pathologies were defined using ICD10-AM codes for the calculation of NTBP prevalence. Logistic regression modelled out-of-hospital predictors of survival to hospital discharge after adjustment for comorbidities. Results: The seven participating hospitals treated 2,277 patients that received paramedic RSI for all illnesses and indications from January 1, 2008 to December 31, 2015, with survival data available for 1,940 (85%). Of the 1,940, 1,125 (58%) patients had at least one hospital-diagnosed NTBP. Sixty-nine percent all of NTBP survived to hospital discharge, compared to 65% for traumatic intracranial injury. Strokes were the most common and had poor survival to discharge (37%) compared to the second most common NTBP toxicity/toxic encephalopathy that had very high survival (98%). No out-of-hospital clinical intervention or prehospital time interval predicted survival. Factors that did predict survival include Glasgow Coma Scale (GCS), duration of mechanical ventilation, age, ICU length of stay, and comorbidities. Conclusions: Non-traumatic brain pathologies are seven times more prevalent than traumatic brain injuries in patients that underwent out-of-hospital RSI in Victoria, Australia. Since the mechanisms through which RSI impacts mortality might differ between traumatic brain injuries and NTBP, and given that NTBP is very prevalent, it follows that the use of RSI in NTBP could be unsupported.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherTaylor & Francis
dc.relation.ispartofpagefrom700
dc.relation.ispartofpageto708
dc.relation.ispartofissue6
dc.relation.ispartofjournalPrehospital Emergency Care
dc.relation.ispartofvolume21
dc.subject.fieldofresearchPublic Health and Health Services not elsewhere classified
dc.subject.fieldofresearchClinical Sciences
dc.subject.fieldofresearchNursing
dc.subject.fieldofresearchPublic Health and Health Services
dc.subject.fieldofresearchcode111799
dc.subject.fieldofresearchcode1103
dc.subject.fieldofresearchcode1110
dc.subject.fieldofresearchcode1117
dc.titleSurvival in Out-of-hospital Rapid Sequence Intubation of Non-Traumatic Brain Pathologies
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
dc.description.versionAccepted Manuscript (AM)
gro.rights.copyright© 2017 Taylor & Francis (Routledge). This is an Accepted Manuscript of an article published by Taylor & Francis in Youth Theatre Journal on 16 Jun 2017, available online: https://doi.org/10.1080/10903127.2017.1325952
gro.hasfulltextFull Text
gro.griffith.authorBoyle, Malcolm


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