title: Urgent airway intervention: does outcome change with personnel performing the procedure?
abstract: BACKGROUND
  Recent studies indicate that prehospital endotracheal intubation (PHEI) is associated with increased septic morbidity. Because the decision to intubate in the field is considered a life-sustaining mandate we analyzed our experience to validate these reports and to compare field intubation to that done in more controlled circumstances on patient arrival at the trauma center.
  
  
  METHODS
  The registry of our Level l trauma center was queried from January 2002 through December 2003 for patients who required emergent EI and had a hospital stay > 2 days. Patients were stratified by site of EI into PHEI and trauma center intubation (TCEI). Demographic data (age, gender, Glasgow Comma Scale, Injury Severity Score) as well as outcome measures (incidence of pneumonia [PNA], Intensive Care Unit length of stay [ICU LOS], hospital length of stay [hospital LOS], and mortality) were compared between groups. Results were subjected to chi2 or unpaired t test, accepting p < 0.05 as significant.
  
  
  RESULTS
  The 628 patients requiring EI consisted of 27l in PHEI and 357 in TCEL. When comparing these groups, PHEI were more severely injured (lower Glasgow Comma Scale score and higher Injury Severity Score), but had no other differences in demographics or in measured outcome variables. Within these groups, patients who developed PNA were comparable. They demonstrated similar time of onset of PNA after injury and had similar incidence of resistant organisms (46%).
  
  
  CONCLUSIONS
  These data demonstrate no increased risk of PNA for urgent prehospital intubation. Moreover, the onset of PNA and the similar bacteriology is reflective of injury severity and not of additional infectious risk posed by these prehospital lifesaving maneuvers.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, University of Florida, Health Science Center, Jacksonville, Florida, USA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Tracy
authors.forename: Miren A
authors.initials: MA
authors.lastname: Schinco
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Griffen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
authors.forename: Terry
authors.initials: T
authors.lastname: Devin
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D004638:Emergency Treatment / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008297:Male; D018410:Pneumonia, Bacterial / Q000209:etiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D014193:Trauma Centers; D016896:Treatment Outcome