Prehospital intubation in patients with severe head injury.
BACKGROUND
Prehospital intubation and airway control is routinely performed by paramedics in critically injured patients. Despite the advantages provided by this procedure, numerous potential risks exist when this is performed in the field. We reviewed the outcome of patients with severe head injury, to determine whether prehospital intubation is associated with an improved outcome.


METHODS
A retrospective review of registry data of patients admitted to an urban trauma center with severe head injury (field Glasgow Coma Scale score of < or =8 and head Abbreviated Injury Scale score of > or =3) was performed. Patients were stratified by methods of airway control performed by prehospital personnel: not intubated, intubated, or unsuccessful intubation. Mortality was determined for each group. To control for significant variables between these populations, matching and multivariate analysis were performed.


RESULTS
Patients requiring prehospital intubation or in whom intubation was attempted had an increased mortality (81% and 77%, respectively) when compared with nonintubated patients (43%). The mortality for patients who had prehospital intubation performed did not demonstrate an improved survival using matching. In fact, intubated patients had a significantly higher relative risk (RR) of mortality when compared with nonintubation (RR = 1.74,p < 0.001) and unsuccessful intubation patients (RR = 1.53, p = 0.008)


CONCLUSIONS
For patients with severe head injury, prehospital intubation did not demonstrate an improvement in survival. Further prospective randomized trials are necessary to confirm these results.
Murray
J A
JA
Department of Surgery, Los Angeles County, University of Southern California Medical Center,  Los Angeles County Department of Health Services, 90033, USA. jamurray@hsc.usc.edu
Demetriades
D
D
Berne
T V
TV
Stratton
S J
SJ
Cryer
H G
HG
Bongard
F
F
Fleming
A
A
Gaspard
D
D
D000293:Adolescent; D000328:Adult; D002648:Child; D006259:Craniocerebral Trauma / Q000401:mortality* / Q000628:therapy*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis