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Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores < 9

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

A Glasgow Coma Scale (GCS) score of 8 or less in patients suffering from severe traumatic brain injury (TBI) represents a decision-making marker in terms of intubation. This study evaluated the impact of prehospital intubation on the mortality of these TBI cases among different age groups.

Methods

This study included the data from patients predominantly suffering from severe TBI [Abbreviated Injury Scale (AIS) of the head ≥ 3, GCS score < 9, Injury Severity Score (ISS) > 9] who were registered in TraumaRegister DGU® from 2002 to 2013. An age-related analysis of five subgroups was performed (1–6, 7–15, 16–55, 56–79, and ≥ 80 years old). The observed and expected mortality were matched according to the Revised Injury Severity Classification, version II.

Results

A total of 21,242 patients were included. More often, the intubated patients were severely injured when compared to the non-intubated patients (median ISS 29, IQR 22–41 vs. 24, IQR 16–29, respectively), with an associated higher mortality (42.2% vs. 30.0%, respectively). When compared to the calculated expected mortality, the observed mortality was significantly higher among the intubated patients within the youngest subgroup (42.2% vs. 33.4%, respectively; p = 0.03).

Conclusions

The observed mortality in the intubated children 1–6 years old suffering from severe TBI seemed to be higher than expected. Whether or not a GCS score of 8 or less is the only reliable criterion for intubation in this age group should be investigated in further trials.

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Author information

Author notes

  1. Pedram Emami and Patrick Czorlich contributed equally and, therefore, share first authorship.

Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany

    Pedram Emami, Patrick Czorlich, Friederike S. Fritzsche & Manfred Westphal

  2. Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Johannes M. Rueger & Michael Hoffmann

  3. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimerstrasse 200, 51109, Cologne, Germany

    Rolf Lefering

Authors
  1. Pedram Emami
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  2. Patrick Czorlich
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  3. Friederike S. Fritzsche
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  4. Manfred Westphal
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  5. Johannes M. Rueger
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  6. Rolf Lefering
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  7. Michael Hoffmann
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TraumaRegister DGU® of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; DGU)

Corresponding author

Correspondence to Pedram Emami.

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Conflict of interest

Rolf Lefering’s Institute (IFOM) has a service agreement with the AUC GmbH who is the owner of the TraumaRegister DGU. This includes support in data analysis for scientific publications. All other authors declare that they have no conflict of interest.

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Emami, P., Czorlich, P., Fritzsche, F.S. et al. Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores < 9. Eur J Trauma Emerg Surg 45, 769–776 (2019). https://doi.org/10.1007/s00068-018-01065-2

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  • DOI: https://doi.org/10.1007/s00068-018-01065-2

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