The impact of prehospital endotracheal intubation on outcome in moderate to severe traumatic brain injury

J Trauma. 2005 May;58(5):933-9. doi: 10.1097/01.ta.0000162731.53812.58.


Background: Although early intubation to prevent the mortality that accompanies hypoxia is considered the standard of care for severe traumatic brain injury (TBI), the efficacy of this approach remains unproven.

Methods: Patients with moderate to severe TBI (Head/Neck Abbreviated Injury Scale [AIS] score 3+) were identified from our county trauma registry. Logistic regression was used to explore the impact of prehospital intubation on outcome, controlling for age, gender, mechanism, Glasgow Coma Scale score, Head/Neck AIS score, Injury Severity Score, and hypotension. Neural network analysis was performed to identify patients predicted to benefit from prehospital intubation.

Results: A total of 13,625 patients from five trauma centers were included; overall mortality was 22.9%, and 19.3% underwent prehospital intubation. Logistic regression revealed an increase in mortality with prehospital intubation (odds ratio, 0.36; 95% confidence interval, 0.32-0.42; p < 0.001). This was true for all patients, for those with severe TBI (Head/Neck AIS score 4+ and/or Glasgow Coma Scale score of 3-8), and with exclusion of patients transported by aeromedical crews. Patients intubated in the field versus the emergency department had worse outcomes. Neural network analysis identified a subgroup of patients with more significant injuries as potentially benefiting from prehospital intubation.

Conclusion: Prehospital intubation is associated with a decrease in survival among patients with moderate-to-severe TBI. More critically injured patients may benefit from prehospital intubation but may be difficult to identify prospectively.

Publication types

  • Evaluation Study

MeSH terms

  • Abbreviated Injury Scale
  • Adult
  • Allied Health Personnel / statistics & numerical data
  • Brain Injuries / classification
  • Brain Injuries / mortality
  • Brain Injuries / therapy*
  • California / epidemiology
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Glasgow Coma Scale
  • Humans
  • Intubation, Intratracheal / statistics & numerical data*
  • Logistic Models
  • Male
  • Outcome and Process Assessment, Health Care
  • Registries
  • Retrospective Studies
  • Survival Analysis