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Prehospital Endotracheal Intubation for Pediatric Trauma: Evaluation of Patient Outcomes Treated at a Level 1 Trauma Center
Harold C. Hamann, BS, Saleem Islam, MD, Janice A. Taylor, MD, Joy M. Perkins, RN, David W. Kays, MD and Shawn D. Larson, MD, University of Florida College of Medicine, Gainesville FL

Abstract: The value of prehospital endotracheal intubation (PEI) in pediatric trauma is unknown. In this study we evaluated patient outcomes for pre-trauma center intubation in pediatric trauma. METHODS: A retrospective review of all pediatric trauma alert patients at a Level-1 Trauma Center (L1TC) from 2006-2013 was performed. Patients were categorized into referral-intubated (Group 1) and scene-intubated (Group 2). Demographic and outcome data were collected and analyzed. RESULTS: Over the 8 year period, 3997 children were admitted following trauma system activation. Patient demographics in Group 1 (n=61) were: males 56%, motor vehicle accident (MVA) 43%, arrival via air transport 39%; and for Group 2 (n=110): male 56%, MVA 78%, arrival via air transport 73%. Both groups had comparable mean ISS (22.0 v. 25.9, p=0.11), GCS, LOS (11.6 v. 8.3 days, p=0.11) and mortality (29.5% v. 28.1%, p=NS). Patients in Group 1 were younger (7.77 v. 10.55 years, p=0.003), had longer time to arrival at a L1TC (84 v. 46.3 min, p<0.05) and required longer duration of intubation (4.88 v. 2.55 days, p=0.05). Pediatric trauma patients intubated at non-L1TCs had greater complication rates compared to Group 2 (30.8% v. 10.6%, p=0.002). CONCLUSIONS: In this retrospective analysis, our results suggest severely injured pediatric patients have better outcomes when intubated at the scene and transported to a L1TC. This insight challenges current state practice where proximity of hospital may contribute to the decision for delayed intubation of critically injured children. Moreover, it demonstrates that PEI is safe when non-physician providers perform intubation at the scene.

Objective: At the end of the activity, the learner will be able to discuss patient outcome following pre-hospital intubation for pediatric trauma.

Objective Content: 1. Discuss the evidence for pre-hospital endotracheal intubation for pediatric trauma. 2. Identify risk factors associated with pre-hospital endotracheal intubation stratified by location of intubation (referring, non-level-1 trauma center versus scene intubation by first responders). 3. Compare outcomes for a large retrospective study comparing pre-hospital intubation settings 4. Discuss recommendations for pre-hospital protocols for air way management in pediatric trauma.

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