title: Prehospital intubation for isolated severe blunt traumatic brain injury: worse outcomes and higher mortality.
abstract: OBJECTIVE
  Prehospital endotracheal intubation (ETI) for traumatic brain injury (TBI) is a controversial issue. The aim of this study was to investigate the effect of prehospital ETI in patients with TBI.
  
  
  METHODS
  Cohort-matched study using the US National Trauma Data Bank (NTDB) 2008-2012. Patients with isolated severe blunt TBI (AIS head ≥3, AIS chest/abdomen <3) and a field GCS ≤8 were extracted from NTDB. A 1:1 matching of patients with and without prehospital ETI was performed. Matching criteria were sex, age, exact field GCS, exact AIS head, field hypotension, field cardiac arrest, and the brain injury type (according PREDOT-code). The matched cohorts were compared with univariable and multivariable regression analysis.
  
  
  RESULTS
  A total of 27,714 patients were included. Matching resulted in 8139 cases with and 8139 cases without prehospital ETI. Prehospital ETI was associated with significantly longer scene (median 9 vs. 8 min, p < 0.001) and transport times (median 26 vs. 19 min, p < 0.001), lower Emergency Department (ED) GCS scores (in patients without sedation; mean 3.7 vs. 3.9, p = 0.026), more ventilator days (mean 7.3 vs. 6.9, p = 0.006), longer ICU (median 6.0 vs. 5.0 days, p < 0.001) and total hospital length of stay (median 10.0 vs. 9.0 days, p < 0.001), and higher in-hospital mortality (31.4 vs. 27.5 %, p < 0.001). In regression analysis prehospital ETI was independently associated with lower ED GCS scores (RC -4.213, CI -4.562/-3.864, p < 0.001) and higher in-hospital mortality (OR 1.399, CI 1.205/1.624, p < 0.001).
  
  
  CONCLUSIONS
  In this large cohort-matched analysis, prehospital ETI in patients with isolated severe blunt TBI was independently associated with lower ED GCS scores and higher mortality.
authors: Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State St, Inpatient Tower (C)-Rm C5L100, Los Angeles, CA, 90033, USA.
authors: Tobias
authors: http://orcid.org/0000-0001-6049-9235
authors: T
authors: Haltmeier
authors: Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State St, Inpatient Tower (C)-Rm C5L100, Los Angeles, CA, 90033, USA.
authors: Elizabeth
authors: E
authors: Benjamin
authors: Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State St, Inpatient Tower (C)-Rm C5L100, Los Angeles, CA, 90033, USA.
authors: Stefano
authors: S
authors: Siboni
authors: Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State St, Inpatient Tower (C)-Rm C5L100, Los Angeles, CA, 90033, USA.
authors: Evren
authors: E
authors: Dilektasli
authors: Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State St, Inpatient Tower (C)-Rm C5L100, Los Angeles, CA, 90033, USA.
authors: Kenji
authors: K
authors: Inaba
authors: Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, 1200 N. State St, Inpatient Tower (C)-Rm C5L100, Los Angeles, CA, 90033, USA. demetria@usc.edu.
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000401:mortality*; D016022:Case-Control Studies; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D014949:Wounds, Nonpenetrating / Q000401:mortality*
keywords: Matched-pair analysis; Outcome; Prehospital care; Prehospital endotracheal intubation; Traumatic brain injury