Abstract : Background :Most trauma societies recommend intubation of trauma patients with Glasgow coma scale (GCS) ≤ 8, without robust evidence supporting it. Methods We examined the association between intubation and inhopital 30 day mortality in trauma patients arriving with GCS ≤ 8. The data were obtained using the Towards Improved Trauma Care Outcomes (TITCO) registry in India cohort. We compared the outcomes of patients with GCS ≤ 8 who were intubated within one hour after arrival with those who were intubated later or not at all, using multiple analytical approaches to evaluate the consistency of the findings. We also examined the association in multiple subgroups to identify any variability of the effect. Results: Of 3476 patients who arrived with a GCS ≤ 8, 1671 (48.1%) were intubated within an hour and 1805 (51.9%) were intubated later or not intubated at all. Overall, 1957 (56.3%) patients died in whole cohort. A total of 947 (56.7%) patients died in intubation group and 1010 (56%) died in non intubation group. In the main analysis, there was no significant association between intubation within an hour and mortality(OR=1.18,[CI,0.76-1.84], p value = 0.467). This result was consistent across multiple sensitivity analysis. Conclusion: In this observational study of trauma patients with GCS ≤ 8, who present to tertiary care hospitals, intubation within one hour after arrival was not associated with increased or decreased risk of inhospital mortality compared to intubation after one hour or no intubation. Further studies are needed to precisely evaluate the benefit of intubation and thus supporting the recommendations.

The authors have declared no competing interest.

The TITCO dataset was funded by grants from the Swedish National Board of Health and Welfare and the Laerdal Foundation for Acute Care Medicine, Norway. The funding agencies had no influence on the conduct of the study, the contents of the manuscript, or the decision to send the manuscript for publication.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee (IEC) of all participating hospitals - Lokmanya Tilak Municipal General Hospital(IEC/11/13 dated 26 Jul 2013), King Edward Memorial Hospital (IEC (I)/out/222/14 dated 4 Mar 2014), Seth Sukhlal Karnani Memorial Hospital (IEC/279 dated 21 Mar 2013, and Jai Prakash Narayan Apex Trauma Centre (IEC/NP-327/2013 RP-24/2013 dated 25 Sep 2013)gave ethical approval for this work.

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

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After signing a data-sharing agreement, the de-identified dataset is available upon request to the authors.

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