Development and Internal Validation of a Preintubation Prediction Model for Postintubation Hypotension in Trauma Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Cohort Study
- 1Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
- 2Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
- 3Department of Emergency Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
Abstract
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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BibTeX
@article{kitsiripant2026development,
title = {{Development and Internal Validation of a Preintubation Prediction Model for Postintubation Hypotension in Trauma Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Cohort Study}},
author = {Chanatthee Kitsiripant and Komet Thongkhao and Osaree Akaraborworn and Siriwimon Tantarattanapong},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208102},
url = {https://www.mdpi.com/2077-0383/15/20/8102},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Development and Internal Validation of a Preintubation Prediction Model for Postintubation Hypotension in Trauma Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Cohort Study
AU - Chanatthee Kitsiripant
AU - Komet Thongkhao
AU - Osaree Akaraborworn
AU - Siriwimon Tantarattanapong
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208102
UR - https://www.mdpi.com/2077-0383/15/20/8102
AB - 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.
SN - 2077-0383
ER -