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Scientific Oral Presentations

Care Equity, Quality, and Safety

Session: Scientific Oral Presentations 2 - Care Equity, Quality, and Safety

Disparities in Emergent Airway Management in Head and Neck Trauma: A National Trauma Database Study

Monday, September 30, 2024
8:48 AM – 8:54 AM EDT
Location: MBCC, 235-237
Disclosure(s):
Katherine E. Xu, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Karthik Rajasekaran, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Emergent airway management for Head and Neck (H&N) trauma patients is particularly challenging due to altered mental status and difficult anatomy, which may necessitate a surgical airway. Here we investigate the epidemiology and impact of hospital status on emergent airway management for H&N trauma patients in the US.

Methods: Retrospective cohort study using the National Trauma Data Bank (2007-15) of patients ≥18 years with H&N trauma and GCS < 9. Excluded were those deceased on ED arrival or with intracranial/burn injuries. Demographics, hospital details, and airway interventions within 24 hours were collected. Multivariate logistic regression was performed in R.

Results: From 5.5 million patients, 207,517 (3.8%) met inclusion criteria (78% male, median age 38 yrs (IQR 26-54)). 67% were White, and 14% Black. The median injury severity score was 25 (14-30). Common mechanisms of injury include motor vehicle trauma (MVT) to occupant (27%), fall (20%), firearm (11%), and MVT to motorcyclist (9.4%). 3.2% received an emergent cricothyrotomy and 71% were intubated within 24 hours. In-hospital mortality was 33%.

Logistic regression adjusting for age, gender, injury, GCS, and ISS showed Black and Hispanic patients were less likely to receive cricothyrotomy (OR 0.89, 95% CI: [0.81,0.97]; 0.84 [0.75, 0.94]). Black patients were less likely to receive intubation (0.81 [0.79, 0.84]). Level II and III trauma centers were less likely to perform cricothyrotomy compared to Level I (0.82 [0.75, 0.90]; 0.35 [0.18, 0.59]). Compared to university hospitals, non-teaching hospitals were less likely to perform cricthyrotomy (0.71 [0.62, 0.80]) and intubation (0.78 [0.75, 0.82]). Community hospitals were more likely to intubate (OR 1.09 [1.06, 1.13]). Lastly, hospitals with >600 beds intervened more than those with fewer beds (Cric: 1.75, [1.41, 2.19], Intub: 1.23 [1.15, 1.31]).

Conclusions: This study highlights the disparities in airway management. Smaller and non-teaching hospitals are less likely to perform emergent airway intervention. Additionally, Black and Hispanic patients are less likely to receive airway intervention.

    Presenting Author(s)

  • Katherine E. Xu, MD

    Resident Physician
    New York Presbyterian Columbia Cornell
    New York, NY, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • DL

    Doreen W. Lam, MD

    Resident
    Cleveland Clinic Head and Neck Institute
    Cleveland, OH, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Karthik Rajasekaran, MD

    Associate Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
    Department of Otorhinolaryngology Head and Neck Surgery, Hospital of the University of Pennsylvania
    Philadelphia, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.