Prehospital endotracheal intubation for severe head injury in children: a reappraisal.
Controversy exists regarding the efficacy of prehospital assisted ventilation by endotracheal intubation (ETI) versus bag-valve-mask (BVM) in serious pediatric head injury. The National Pediatric Trauma Registry (NPTR-3) data set was analyzed to examine this question. NPTR-3 (n = 31,464) was queried regarding the demographics, injury mechanism, injury severity, prehospital interventions, transport mode, mortality rate, injury complications, procedure and equipment failure or complications, and functional outcome of seriously head-injured patients (n = 578) with comparable injury mechanisms and injury severity who received endotracheal intubation (ETI) (n = 479; 83%) versus those who received BVM (n = 99; 17%). Mortality rate was virtually identical between the 2 groups (ETI = 48%, BVM = 48%), although children receiving ETI were significantly older (P < .01), more often transported by helicopter (P < .01), and more often received intravenous fluid in the field (P < .05). However, injury complications affecting nearly every body system or organ (except kidney, gut, and skin) occurred less often in children receiving ETI (ETI = 58%, BVM = 71%, P < .05). Procedure and equipment failure or complications, and functional outcome, were similar between the 2 groups. Prehospital endotracheal intubation appears to offer no demonstrable survival or functional advantage when compared with prehospital bag-valve-mask for prehospital assisted ventilation in serious pediatric head injury. Injury complications appear to occur somewhat less often among patients intubated in the field.
Cooper
A
A
Division of Pediatric Surgery, Columbia University College of Physicians & Surgeons, Harlem Hospital Center, 506 Lenox Ave, 10037 New York, NY, USA.
DiScala
C
C
Foltin
G
G
Tunik
M
M
Markenson
D
D
Welborn
C
C
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000145:classification / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008297:Male; D012042:Registries; D016896:Treatment Outcome