title: Outcomes following prehospital airway management in severe traumatic brain injury.
abstract: BACKGROUND
  Prevention of hypoxia and thus secondary brain injury in traumatic brain injury (TBI) is critical. However there is controversy regarding the role of endotracheal intubation in the prehospital management of TBI.
  
  
  OBJECTIVE
  To describe the outcome of TBI with various airway management methods employed in the prehospital setting in the Cape Town Metropole.
  
  
  METHODS
  The study was a cohort descriptive observational analysis of 124 consecutively injured adult patients who were admitted for severe TBI (Glasgow Coma Score ≤8) to Groote Schuur and Tygerberg hospitals between 1 January 2009 and 31 August 2011. Patients were categorised by their method of airway management: rapid sequence intubation (RSI), sedation-assisted intubation, failed intubation, basic airway management, and intubated without drugs. Good outcomes were defined by a Glasgow Outcome Score of 4 - 5.
  
  
  RESULTS
  There was a statistically significant association between airway management and outcome (p=0.013). Patients who underwent basic airway management had a higher proportion of a good outcome (72.9%) than patients who were intubated in the prehospital setting. A good outcome was observed with 61.8% and 38.4% of patients who experienced sedation-assisted intubation and RSI, respectively. Patients intubated without drugs had the poorest outcome (88%), followed by rapid sequence intubation (61.5%) and by the sedation assisted group (38.2%).
  
  
  CONCLUSIONS
  Prehospital intubation did not demonstrate improved outcomes over basic airway management in patients with severe TBI. A large prospective, randomised trial is warranted to yield some insight into how these airway interventions influence outcome in severe TBI.
authors.affiliation: Department of Emergency Medical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa. simpiwesobuwa@gmail.com.
authors.forename: Simpiwe
authors.initials: S
authors.lastname: Sobuwa
authors.forename: Henry B
authors.initials: HB
authors.lastname: Hartzenberg
authors.forename: Heike
authors.initials: H
authors.lastname: Geduld
authors.forename: Corrie
authors.initials: C
authors.lastname: Uys
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D016292:Procedural Sedation / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000503:physiopathology; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control*; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D013019:South Africa / Q000453:epidemiology; D061665:Time-to-Treatment