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Indications for prehospital intubation among severely injured children and the prevalence of significant traumatic brain injury among those intubated due to impaired level of consciousness

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

Abstract

Background

Prehospital endotracheal intubation (PEI) of head injured children with impaired level of consciousness (LOC) aims to minimize secondary brain injury. However, PEI is controversial in otherwise stable children. We aimed to investigate the indications for PEI among pediatric trauma patients and the prevalence of clinically significant traumatic brain injury (csTBI) among those intubated solely due to impaired consciousness.

Methods

This is a multicenter retrospective cohort study of children who underwent PEI in northern Israel between January 2014 and December 2020 by six EMS agencies and were transported to two trauma centers in the area. We extracted data from EMS records and trauma registries.

Results

PEI was attempted in 179/986 (18.2%) patients and was successful in 92.2% of cases. Common indications for PEI were hypoxemia not corrected by supplemental oxygen (n = 30), traumatic cardiac arrest (n = 16), and facial injury compromising the airway (n = 13). 112 patients (62.6%) were intubated solely due to impaired or deteriorating LOC. Among these patients, 68 (62.4%) suffered csTBI. The prevalence of csTBI among those with field Glasgow Coma Scale (GCS) of 3, 4–8, and > 8 was 81.4%, 55.8%, and 28.6%, respectively (p < 0.001). Among children ≤ 10 years old intubated due to impaired LOC, 50% had csTBI.

Conclusion

Impaired LOC is a major indication for PEI. However, a significant proportion of these patients do not suffer csTBI. Older age and lower pre-intubation GCS are associated with more accurate field classification. Our data indicate that further investigation and better characterization of patients who may benefit from PEI is necessary.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

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Author information

Authors and Affiliations

  1. Pediatric Emergency Department, Schneider Children’s Medical Center, Petah Tikva, Israel

    Nir Samuel

  2. Pediatric Intensive Care Unit, Galilee Medical Center, Nahariya, Israel

    Yoav Hoffmann

  3. Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel

    Stav Rakedzon

  4. Emergency Department, Emek Medical Center, Afula, Israel

    Ari M. Lipsky

  5. Anesthesiology Department, Rambam Health Care Campus, Haifa, Israel

    Aeyal Raz

  6. Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Aeyal Raz & Hany Bahouth

  7. Trauma and Emergency Surgery, Rambam Health Care Campus, Haifa, Israel

    Hen Ben Lulu & Hany Bahouth

  8. Critical Care Division, Rambam Health Care Campus, Haifa, Israel

    Danny Epstein

Authors
  1. Nir Samuel
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  2. Yoav Hoffmann
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  4. Ari M. Lipsky
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  8. Danny Epstein
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Corresponding author

Correspondence to Danny Epstein.

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Conflict of interest

AR reports receiving consultation fees from Medtronic and Neuroindex and presenting a seminar for Merck, Sharp & Dohme (unrelated to this project). All other authors declare that they have no conflicts of interest.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Rambam Health Care Campus and Galilee Medical Center. The need for written informed consent was waived due to the retrospective study design.

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Not applicable.

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Samuel, N., Hoffmann, Y., Rakedzon, S. et al. Indications for prehospital intubation among severely injured children and the prevalence of significant traumatic brain injury among those intubated due to impaired level of consciousness. Eur J Trauma Emerg Surg 49, 1217–1225 (2023). https://doi.org/10.1007/s00068-022-01983-2

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  • DOI: https://doi.org/10.1007/s00068-022-01983-2

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