Prehospital intubation in patients with severe head injury

Background: Prehospital intubation and airway control is routinely performe d by paramedics in critically injured patients. Despite the advantages prov ided hy this procedure, numerous potential risks exist when this is perform ed in the field. We reviewed the outcome of patients with severe head injur y, to determine whether prehospital intubation is associated with an improv ed outcome, Methods: A retrospective review of registry data of patients admitted to an urban trauma center with severe head injury (field Glasgow Coma Scale scor e of less than or equal to8 and head Abbreviated Injury Scale score of grea ter than or equal to3) was performed. Patients were stratified by methods o f airway control performed by prehospital personnel: not intubated, intubat ed, or unsuccessful intubation, Mortality was determined for each group. To control for significant variables between these populations, matching and multivariate analysis were performed, Results: Patients requiring prehospital intubation or in whom intubation wa s attempted had an increased mortality (81% and 77%, respectively) when com pared with nonintubated patients (43%). The mortality for patients who had prehospital intubation performed did not demonstrate an improved survival u sing matching. In fact, intubated patients had a significantly higher relat ive risk (RR) of mortality when compared with nonintubation (RR = 1.74,p < 0.001) and unsuccessful intubation patients (RR = 1.53, p = 0.008) Conclusion: For patients with severe head injury, prehospital intubation di d not demonstrate an improvement in survival, Further prospective randomize d trials are necessary to confirm these results.