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

2. Outline
Background
Methodology
Result
Discussion
Conclusion

3. Background
Airway Management

4. Un intentional Injuries
Background (world)
Deaths(1,000) in 2011
Un intentional Injuries
WHO,2011

5. Background (Thailand)
IS;153,237, Dead 6,928 Case Fatality Rate=4.52%
400
300
200
1.57
292
279
242
258
1.29
211
1.00
0.78
0.71
0.82
100
0.70
0.71
0.59
0.57
New Year
Normally
number/day
number/day
Deaths Rate Per 100,000 Population
IS: Road Traffic Accident ,Khon Kaen

6. Background (Pre-hospital care)
Emergency Medical Institute
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 (Injury Surveillance : IS) severe injury patients almost referred to hospital by EMS 36.11% relatve 61.19% and non registered organization 0.4%(2009)

7. Background (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%
*Standard setting: %not more than 5% of all injury case who need medical care

8. Prior Studies (The pre-hospital airway management )
Los Angeles study ( )
Pre-hospital endotracheal intubation in isolated, moderate to severe TBI patients is associated with a nearly 5-fold increase in mortality.
Cudnik,et al. [2010]
After adjusting for these differences, use of pre-hospital RSI-ETI was not associated with improved survival.

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

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

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

12. Materials and Methods 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

13. Results 1Target Population

14. Demographic Characteristics
Results
Demographic Characteristics
Gender: 64.74%, were male
Age: mean age of 31.86(19.54)
Ranged 0-99 years
Occupation:
labors (39.62 %)
student (26.06%)
agricultural (6.57%)

15. Results

16. Results Number of pre-hospitsl care Pre-hospital Care non but needed
Improperly
done
Properly done
unnecessary
Airway 31 9
1,534
21,461
Bleeding control
1187
(5.15%) 45
6,357
15,446
C-spine immobilization 41 5
1,984
21,005
Splint
133 8
4,835
18,059
IV Fluid 38 2
4,074
18,921

17. Results

18. 2. Bivariate Analysis

19. 3. Multivariate analysis of all patients
*Adjust for gender, age, cause of accidents, alcohol drinking, stop bleeding, intravenous fluid and consciousness

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)
Relative
Eyewitness
EMS
Non registered organization
Different skill

21. Discussion Then….. (ORadj 3.42 , 95% CI: 0.42 to27.91, p< 0.001)
Los Angeles study
After adjusting for possible confounding factors, multivariable logistic regression analysis demonstrated that PHI was independently associated with increased mortality (AOR 5, 95% CI: 1.7–13.7, P
(0.004)
Cudnik,et al.
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)

22. Discussion
Limitations
Small sample size
confounding factors
Bias

23. 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.

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

25. Thank you for your attention