Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury.
OBJECTIVE
There is an absence of prospective data evaluating the impact of prehospital intubation in adult trauma patients. Our objectives were to determine the outcome of trauma patients intubated in the field who did not have an acutely lethal traumatic brain injury (death within 48 hours) compared with patients who were intubated immediately on arrival to the hospital.


METHODS
Prospective data were collected on 191 consecutive patients admitted to the trauma center with a field Glasgow Coma Scale score < or = 8 and a head Abbreviated Injury Scale score > or = 3 who were either intubated in the field or intubated immediately at admission to the hospital. Patients who died within 48 hours of admission and transfers were excluded from the study.


RESULTS
Of the 191 patients, 176 (92%) sustained blunt trauma and 25 (8%) were victims of penetrating trauma. Seventy-eight (41%) of the 191 patients were intubated in the field and 113 (59%) were intubated immediately at admission. There was no significant difference in age, Glasgow Coma Scale score, head Abbreviated Injury Scale score, or Injury Severity Score between the two groups. Patients who were intubated in the field had a significantly higher morbidity (ventilator days, 14.7 vs. 10.4; hospital days, 20.2 vs. 16.7; and intensive care unit days, 15.2 vs. 11.7) compared with patients intubated on immediate arrival to the hospital and nearly double the mortality (23% vs. 12.4). Field-intubated patients had a 1.5 times greater risk of nosocomial pneumonia compared with hospital-intubated patients.


CONCLUSIONS
Prehospital intubation is associated with a significant increase in morbidity and mortality in trauma patients with traumatic brain injury who are admitted to the hospital without an acutely lethal injury. A randomized, prospective study is warranted to confirm these results.
Bochicchio
Grant V
GV
R Adams Cowley Shock Trauma Center and University of Maryland Medical School, Baltimore, 21201, USA. gbochicchio@umm.edu
Ilahi
Obeid
O
Joshi
Manjari
M
Bochicchio
Kelly
K
Scalea
Thomas M
TM
D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000145:classification / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008396:Maryland; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome