title: The Effects of Pediatric Advanced Life Support Guidelines on Pediatric Trauma Airway Management.
abstract: OBJECTIVE
  Recent Pediatric Advanced Life Support (PALS) guidelines have deemphasized the use of advanced airways in short transport. It is unclear if guideline recommendations have altered practice. We sought to determine if a temporal change exists in the number of prehospital pediatric trauma intubations since the 2005 PALS guidelines update.
  
  
  METHODS
  This is an institutional review board-approved, retrospective, single-center study. Reviewed all pediatric trauma activations where patients younger than 19 years were intubated at the scene, en route or at the level 1 trauma center during 2006 to 2011. Specific complications collected were esophageal intubations, mainstem intubations and need for re-intubations.
  
  
  RESULTS
  There were 1012 trauma activations, 1009 pediatric patients, 300 (29.7%) intubated during transport to Children's Hospital of Wisconsin Pediatric Trauma Center (PTC) or upon arrival. Mean age of 9.5 ± 5.9 years. Fifty-seven percent (n = 172) were intubated before PTC, 31.7% (n = 95) field intubations, 25.7% (n = 77) outside facility intubations. 44% (n = 132) at PTC. Age was not a significant variable. There was no difference in the proportion of injured children requiring intubation who were intubated before arrival to the PTC. Those intubated in the field versus a facility had significantly increased mortality (P = 0.0002), longer hospital days (P = 0.0004) including intensive care unit days (P = 0.0003) and ventilator days (P = 0.0003) even when adjusted for illness severity.
  
  
  CONCLUSIONS
  There was no significant change in the proportion of pretrauma room intubations following the 2005 PALS guidelines even when adjusted for illness or injury severity. Children injured farther from the PTC and more severely injured children were more likely to be intubated before arrival at the PTC.
authors.affiliation: From the *Division of Critical Care, Department of Pediatrics, and †Division of Quantitative Health Sciences Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jana
authors.initials: J
authors.lastname: Sperka
authors.forename: Sheila J
authors.initials: SJ
authors.lastname: Hanson
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.forename: Mahua
authors.initials: M
authors.lastname: Dasgupta
authors.forename: Michael T
authors.initials: MT
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D058109:Airway Management / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000401:mortality; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers