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

2. Outline Background & Rational Objective Methodology Result Discussion Conclusion

3. Background & Rationale Road Traffic Accidents Death Rate Per 100,000Data; Source: WHO 2011

4. Background & Rationale (World Wide) Causes of injuries,2011 WHO 2011

5. Background & Rationale (Thailand) Top 5 Caused of death,2010

6. Background & Rationale (Khon Kaen) 2550 2551 2552 2553 2554 12000 10000 8000 6000 4000 2000 284 235 216 283 254 40.57 40.43 982310131 8715 87238811 33.57 36.29 24.34 24.3724.61 27.44 28.30 New Year Normally number/day 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

7. Background & Rationale (Pre-hospital care) 2010-2012crisis 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 (National Injury Surveillance) severe injury patients almost referred to hospital by EMS 36.11% relationship 61.19% and non registered organization 0.4%

8. Background & Rationale (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%

9. Los Angeles study Pre-hospital endotracheal intubation in isolated, moderate to severe TBI patients is associated with a nearly 5-fold increase in mortality. Further prospective studies are required to establish guide- lines for optimal pre-hospital management of this critically injured patient population Prior Studies (The pre-hospital airway management )

10. Cudnik,et al. [2010] There were 877 consecutive trauma patients who had pre-hospital ETI during this period and were included in the analysis. Of these, 496 (57%) had RSI-ETI. In univariate analyses, those with RSI-ETI had less severe injuries, better pre-hospital physiology lower unadjusted mortality than those intubated without RSI. However, 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)

11. Gabs of Knowledge ignored to shown the test of association or measurement this study purpose to investigate the effect of pre-hospital airway management on the mortality

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

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

14. 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

15. Results 1Target Population

16. Results 2.Demographic Characteristics 25,838 injury patients, accident (89.21%), assault (9.46%) intension self–harm (1.33%) 23,035 traumatic accident patients 64.74%, were male mean age of 31.86(19.54) labors (39.62 %), student (26.06%), agricultural, (6.57%) Trauma due to transportation 43.59%, Trauma due to 56.40% in the others. (approve in Chart)

17. 2. Bivariate Analysis

18. 3. Multivariate analysis of all patients

19. Result Factors associated with Mortality

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) Then….. (ORadj 3.42, 95% CI: 0.42 to27.91, p< 0.001)

21. Discussion Theoretical principle Los Angeles study Cudnik,et al. Strength & Limitations Small sample size confounding factors bias

22. 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.

23. Acknowledgement Trauma and Critical Care Center of Khon Kaen Hospital Assoc. Prof.Dr.Bandit Thinkamrop Mr. Kavin Thinkamrop Miss.Jitjira Chaiyarit Miss. Wilaipron Thinkamrop

24. Thank you for your attention