The need for standardized data reporting for prehospital airway management

Davis, Daniel P.

doi:10.1186/cc10039

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…A main finding and conclusion of this study is that, due to multiple confounders and possible interactions in the logistically complex prehospital situation, the merits or dangers of prehospital intubation are difficult to adequately assess in a retrospective study. As has been previously mentioned by other groups, well-designed prospective study protocols are warranted to answer this question ( 77 , 78 ), but even then it will be difficult in the heterogeneous injury as TBI. In aggregate, this study suggests that decisions to intubate or not at the scene are based on judgments that are multi-factorial and hard to quantify for analysis, but are generally correct in the study region.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Intubation and Outcome in Traumatic Brain Injury—Assessing Intervention Efficacy in a Modern Trauma Cohort

et al. 2018

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BackgroundPrehospital intubation in traumatic brain injury (TBI) focuses on limiting the effects of secondary insults such as hypoxia, but no indisputable evidence has been presented that it is beneficial for outcome. The aim of this study was to explore the characteristics of patients who undergo prehospital intubation and, in turn, if these parameters affect outcome.Material and methodsPatients ≥15 years admitted to the Department of Neurosurgery, Stockholm, Sweden with TBI from 2008 through 2014 were included. Data were extracted from prehospital and hospital charts, including prospectively collected Glasgow Outcome Score (GOS) after 12 months. Univariate and multivariable logistic regression models were employed to examine parameters independently correlated to prehospital intubation and outcome.ResultsA total of 458 patients were included (n = 178 unconscious, among them, n = 61 intubated). Multivariable analyses indicated that high energy trauma, prehospital hypotension, pupil unresponsiveness, mode of transportation, and distance to the hospital were independently correlated with intubation, and among them, only pupil responsiveness was independently associated with outcome. Prehospital intubation did not add independent information in a step-up model versus GOS (p = 0.154). Prehospital reports revealed that hypoxia was not the primary cause of prehospital intubation, and that the procedure did not improve oxygen saturation during transport, while an increasing distance from the hospital increased the intubation frequency.ConclusionIn this modern trauma cohort, prehospital intubation was not independently associated with outcome; however, hypoxia was not a common reason for prehospital intubation. Prospective trials to assess efficacy of prehospital airway intubation will be difficult due to logistical and ethical considerations.

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Section: Discussionmentioning

confidence: 99%

Prehospital Intubation and Outcome in Traumatic Brain Injury—Assessing Intervention Efficacy in a Modern Trauma Cohort

et al. 2018

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“…To date, twenty-two articles have described data collection methods adhering to, or adapted to, the original Utstein-style airway template [ 3 , 5 , 8 , 21 – 23 , 50 , 52 – 66 ]. A further twenty-three articles have referred to the original publication [ 6 , 8 , 13 , 16 , 35 , 36 , 41 , 67 – 82 ]. However, as technology evolves, the availability of new possibilities of data capture from devices like video or body cameras, or streaming of monitor data directly to hospital data systems, may influence this kind of research [ 83 , 84 ].…”

Section: Discussionmentioning

confidence: 99%

“…Results from research on PHAAM are challenged by heterogeneity in provider competence, airway techniques, and the quality of data collected in many airway studies [ 4 ]. To improve pre-hospital critical care and to develop evidence-based guidelines, research based on standardised high-quality data is important [ 5 , 6 ]. Using a common and uniform set of data definitions may be the first step in such a process [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Standardised data reporting from pre-hospital advanced airway management – a nominal group technique update of the Utstein-style airway template

Sunde

Kottmann

Heltne

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundPre-hospital advanced airway management with oxygenation and ventilation may be vital for managing critically ill or injured patients. To improve pre-hospital critical care and develop evidence-based guidelines, research on standardised high-quality data is important. We aimed to identify which airway data were most important to report today and to revise and update a previously reported Utstein-style airway management dataset.MethodsWe recruited sixteen international experts in pre-hospital airway management from Australia, United States of America, and Europe. We used a five-step modified nominal group technique to revise the dataset, and clinical study results from the original template were used to guide the process.ResultsThe experts agreed on a key dataset of thirty-two operational variables with six additional system variables, organised in time, patient, airway management and system sections. Of the original variables, one remained unchanged, while nineteen were modified in name, category, definition or value. Sixteen new variables were added. The updated dataset covers risk factors for difficult intubation, checklist and standard operating procedure use, pre-oxygenation strategies, the use of drugs in airway management, airway currency training, developments in airway devices, airway management strategies, and patient safety issues not previously described.ConclusionsUsing a modified nominal group technique with international airway management experts, we have updated the Utstein-style dataset to report standardised data from pre-hospital advanced airway management. The dataset enables future airway management research to produce comparable high-quality data across emergency medical systems. We believe this approach will promote research and improve treatment strategies and outcomes for patients receiving pre-hospital advanced airway management.Trial registrationThe Regional Committee for Medical and Health Research Ethics in Western Norway exempted this study from ethical review (Reference: REK-Vest/2017/260).Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0509-y) contains supplementary material, which is available to authorized users.

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“…In 2009, an Utstein template for documenting and reporting pre-hospital advanced airway management was published [ 42 ]. This template may increase the validity of future studies on this subject [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

Fevang

Lockey

Thompson

et al. 2011

Scand J Trauma Resusc Emerg Med

126

121

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BackgroundPhysician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care.MethodsA European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting.ResultsThe expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services.ConclusionA modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

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The need for standardized data reporting for prehospital airway management

Cited by 12 publications

References 20 publications

Prehospital Intubation and Outcome in Traumatic Brain Injury—Assessing Intervention Efficacy in a Modern Trauma Cohort

Prehospital Intubation and Outcome in Traumatic Brain Injury—Assessing Intervention Efficacy in a Modern Trauma Cohort

Standardised data reporting from pre-hospital advanced airway management – a nominal group technique update of the Utstein-style airway template

The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

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