ENDOTRACHEAL INTUBATION IN THE FIELD IMPROVES SURVIVAL IN PATIENTS WITH SEVERE HEAD-INJURY

Objective: To measure the effect of prehospital endotracheal intubatio n on outcome in patients with severe head injury and the percentage of these patients intubated in the field under existing protocol. Design : Retrospective case-control study. Setting: Countywide urban trauma s ystem. Patients: Trauma patients with blunt injury and scene Glasgow C oma Score of 8 or less, transported by ground ambulance with advanced life support capabilities from January 1, 1991, to December 31, 1995. Severe head injury was defined as head or neck Abbreviated Injury Scal e score of 4 or greater. Isolated severe head injury was defined as he ad or neck Abbreviated Injury Scale score of 4 or greater with no othe r Abbreviated Injury Scale component greater than 3. One thousand nine ty-two patients met initial criteria; of these, 671 had severe head in jury, and 351 had isolated severe head injury. Interventions: None. Ma in Outcome Measures: Mortality and functional status sufficient for di scharge to home. Results: Field intubation was associated with signifi cant decreases in mortality from 36% to 26% in the full study group, f rom 57% to 36% in patients with severe head injury, and from 50% to 23 % in patients with isolated severe head injury. Rate of discharge to h ome was unaffected by field intubation. Between 50% and 60% of study p atients were intubated under current paramedic protocol, compared with intubation rates of 85% to 92% for similar patients transported by ae romedical teams operating under expanded indications for intubation. C onclusions: Prehospital endotracheal intubation was associated with im proved survival in patients with blunt injury and scene Glasgow Coma S core of 8 or less, especially those with severe head injury by anatomi c criteria. Broadening indications for intubation by paramedical perso nnel has great potential to improve outcome in patients with severe he ad injury.