title: The Effect of Prehospital Intubation on Treatment Times in Patients With Suspected Traumatic Brain Injury.
abstract: OBJECTIVE
  This study examines whether, in patients requiring intubation with moderate to severe traumatic brain injury (TBI), prehospital intubation compared with emergency department intubation leads to a reduction in treatment times and time to a computed tomographic (CT) scan.
  
  
  METHODS
  A retrospective cohort study compared adult patients with a Glasgow Coma Score of less than 14 with a suspected TBI who underwent intubation, either prehospital or on arrival to the emergency department.
  
  
  RESULTS
  Prehospital intubation was associated with a decreased time from emergency department arrival to CT scan compared with emergency department intubation (43 vs. 54 minutes, P < .001). The prehospital intubation group had a longer median scene time (42 vs. 17 minutes, P ≤ .001), longer median transport times (32 vs. 14 minutes, P ≤ .001), and longer total treatment times (90 vs. 73 minutes, P = .007).
  
  
  CONCLUSIONS
  Patients intubated in the prehospital setting spend a longer time at the scene but a shorter amount of time in the emergency department before brain imaging. Prehospital intubation may lead to earlier control of airway and ventilation. The minority of intubated TBI patients required urgent neurosurgical intervention. Overall prehospital intubation shows no significant survival advantage for the patients when compared with emergency department intubation.
authors.affiliation: Department of Surgery, St George Hospital, NSW, Australia; Department of Trauma Services, St George Hospital, NSW, Australia. Electronic address: joshlanson@gmail.com.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lansom
authors.affiliation: Department of Trauma Services, St George Hospital, NSW, Australia; Sydney Nursing School, University of Sydney, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.affiliation: Department of Trauma Services, St George Hospital, NSW, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Goldsmith
authors.affiliation: Department of Emergency Medicine, St George Hospital, NSW, Australia; Greater Sydney Area HEMS, NSW, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Tzannes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000628:therapy*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed; D055815:Young Adult