Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis

Prehosp Disaster Med. 2014 Feb;29(1):32-6. doi: 10.1017/S1049023X13008947. Epub 2013 Dec 13.


Introduction: Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant.

Hypothesis: Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied.

Methods: This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS).

Results: Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS.

Conclusion: In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.

MeSH terms

  • Abbreviated Injury Scale
  • Adult
  • Blood Gas Analysis
  • Case-Control Studies
  • Craniocerebral Trauma / mortality
  • Craniocerebral Trauma / therapy*
  • Emergency Medical Services*
  • Female
  • Glasgow Coma Scale
  • Hospital Mortality
  • Hospitals, Urban
  • Humans
  • Intubation, Intratracheal / adverse effects*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Propensity Score
  • Retrospective Studies
  • Trauma Centers
  • Treatment Outcome