• Am J Emerg Med · Apr 2018

    Observational Study

    Association of prehospital intubation with decreased survival among pediatric trauma patients in Iraq and Afghanistan.

    • Steven G Schauer, Jason F Naylor, Guyon J Hill, Allyson A Arana, Jamie L Roper, and Michael D April.
    • US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States; 59th Medical Wing, Lackland Air Force Base, TX, United States; Brooke Army Medical Center, JBSA Fort Sam Houston, TX, United States. Electronic address: steven.g.schauer.mil@mail.mil.
    • Am J Emerg Med. 2018 Apr 1; 36 (4): 657-659.

    IntroductionAirway compromise is the second leading cause of preventable death on the battlefield among US military casualties. Airway management is an important component of pediatric trauma care. Yet, intubation is a challenging skill with which many prehospital providers have limited pediatric experience. We compare mortality among pediatric trauma patients undergoing intubation in the prehospital setting versus a fixed-facility emergency department.MethodsWe queried the Department of Defense Trauma Registry (DODTR) for all pediatric encounters in Iraq and Afghanistan from January 2007 to January 2016. We compared outcomes of pediatric subjects undergoing intubation in the prehospital setting versus the emergency department (ED) setting.ResultsDuring this period, there were 3439 pediatric encounters (8.0% of DODTR encounters during this time). Of those, 802 (23.3%) underwent intubation (prehospital=211, ED=591). Compared to patients undergoing ED intubation, patients undergoing prehospital intubation had higher median composite injury severity scores (17 versus 16) and lower survival rates (66.8% versus 79.9%, p<0.001). On univariable logistic regression analysis, prehospital intubation increased mortality odds (OR 1.97, 95% CI 1.39-2.79). After adjusting for confounders, the association between prehospital intubation and death remained significant (OR 2.03, 95% CI 1.35-3.06).ConclusionsPediatric trauma subjects intubated in the prehospital setting had worse outcomes than those intubated in the ED. This finding persisted after controlling for measurable confounders.Published by Elsevier Inc.

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