Analysis of prehospital pediatric and adult intubation.
OBJECTIVE
Pediatric airway control, including endotracheal intubation (ETI), presents a clinical challenge in the prehospital setting. Endotracheal intubation is recommended for serious head injury (Glasgow Coma Scale score <=8). We evaluated the frequency of ETI in pediatric and adult patients with <=8 in the field, subsequently transported by a hospital-based, helicopter emergency medical service (HHEMS).


METHODS
A retrospective, descriptive study of pediatric patients (<=14 years) and adult patients with GCS <=8 transported by HHEMS from January 1988 through March 1994 was conducted. Significance was determined by chi-square analysis.


RESULTS
Inclusion criteria were met by 63 (15%) pediatric patients and 353 (85%) adults. Of the pediatric patients, 38 (60%) were intubated endotracheally; mean age was 7; mean injury severity score (ISS) was 28. Of adults, 267 (76%) were intubated endotracheally; mean age was 35; mean ISS was 33. A 16-percentage-point difference in frequency of successful ETI between groups was found to be significant (p <=0.01). Of 25 nonintubated pediatric (PED) patients, unsuccessful attempts were made on 20 (80%); 14 of 25 (56%) had significant head injuries evident on computerized tomography (CT) scan. Of 86 nonintubated adults, unsuccessful attempts were made on 29 (34%); 61 (71%) had significant head injuries.


CONCLUSIONS
Pediatric coma patients were not intubated with the same frequency as adults. This discrepancy between groups was secondary to a higher failure rate in the pediatric group. Intubation was attempted in 92% of pediatric patients versus 84% of the adults. Unsuccessful intubation attempts in the pediatric group, 20 of 58 (34%), were compared with 29 of 296 (9.8%) in the adult group. Difficulty in pediatric airway control may require an increased level of training and experience.
Boswell
W C
WC
Memorial Medical Center, Savannah, GA 31403, USA.
McElveen
N
N
Sharp
M
M
Boyd
C R
CR
Frantz
E I
EI
D000328:Adult; D017732:Air Ambulances / Q000592:standards*; D016009:Chi-Square Distribution; D002648:Child; D002983:Clinical Competence; D006259:Craniocerebral Trauma / Q000145:classification / Q000150:complications / Q000628:therapy*; D004632:Emergency Medical Services / Q000592:standards*; D005845:Georgia / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers; D017211:Treatment Failure