Kim et al developed an index for identifying a trauma patient who might have an unplanned intubation. Unplanned intubations are associated with worse outcomes. The authors are from the University of California San Diego.
Patient selection: trauma patient who has arrived at a trauma center (prehospital and transfer intubations excluded)
Parameters:
(1) age in years
(2) gender
(3) Glasgow coma score (GCS)
(4) seizures
(5) COPD
(6) traumatic brain injury (TBI)
(7) number of rib fractures
(8) spine fracture(s)
(9) long bone fracture(s)
|
Parameter |
Finding |
Points |
|
age in years |
< 55 years |
0 |
|
|
55 to 64 years |
2 |
|
|
>= 65 years |
3 |
|
gender |
female |
0 |
|
|
male |
1 |
|
Glasgow coma score |
9 to 13 |
2 |
|
|
3 to 8 |
0 |
|
seizures |
no |
0 |
|
|
yes |
2 |
|
COPD |
no |
0 |
|
|
yes |
2 |
|
traumatic brain injury |
no |
0 |
|
|
yes |
1 |
|
number of rib fractures |
0 to 3 |
0 |
|
|
>= 4 |
2 |
|
spine fractures |
no |
0 |
|
|
yes |
2 |
|
long bone fractures |
no |
0 |
|
|
yes |
2 |
where:
• A patient with a low GCS is probably already intubated.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• The higher the score the greater the risk for an unplanned intubation.
• A score of 6 was associated with a 10% chance of unplanned intubation, a score of 7 20%, a score of 9 40% and a score of 10 100% (Figure 2).
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
