Development and Internal Validation of a Preintubation Prediction Model for Postintubation Hypotension in Trauma Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Cohort Study

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Background/Objectives: Postintubation hypotension (PIH) is an important complication of emergency endotracheal intubation in trauma patients. However, the applicability of preintubation predictors of PIH in trauma patients undergoing emergency endotracheal intubation in the emergency department (ED) remains uncertain. Here, we aimed to develop and internally validate a preintubation prediction model for PIH in such patients. Methods: This retrospective cohort included trauma patients aged ≥ 15 years undergoing emergency endotracheal intubation in the ED during 2015–2023. PIH was defined as systolic blood pressure < 90 mmHg within 30 min after intubation. Eight preintubation candidate predictors were evaluated using logistic regression with backward elimination. Internal validation used 2000 bootstrap resamples repeating the entire variable-selection procedure. Results: Among 348 patients, 60 (17.2%) developed PIH; 345 patients with 57 PIH events had complete data for model development. The final model retained systolic blood pressure, body temperature, hematocrit, and torso injury, with adjusted odds ratios of 1.19 per 10-mmHg lower systolic blood pressure, 1.48 per 1 °C lower temperature, 1.33 per 5-percentage-point lower hematocrit, and 3.26 for torso injury. The apparent and optimism-corrected areas under the receiver operating characteristic curve were 0.742 and 0.700, respectively. Conclusions: A four-variable preintubation prediction model demonstrated modest optimism-corrected discrimination and substantial model-selection uncertainty. External validation and assessment of clinical utility are required before clinical implementation.

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Related topics: Airway Management and Intubation Techniques · Trauma and Emergency Care Studies · Respiratory Support and Mechanisms