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

Abstract

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 <15 (group 3, N = 58) and ISS >15 (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 < 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 < 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 < 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.