Early Intubation Of Pediatric Trauma Patients: Do Surgeons Need To Show Up?
*Paul McGaha1, Kenneth Stewart1, Tabitha Garwe1, Jeremy Johnson1, *Robert Letton2
1University of Oklahoma Health Science Center, Oklahoma City, OK;2Nemours Children's Specialty Care, Jacksonville, FL
BACKGROUND: Airway compromise is one of the American College of Surgeons (ACS) six minimum criteria for full team trauma activation. We aimed to evaluate the association of early intubation in pediatric trauma patients delivered directly to the trauma center with the need for surgeon presence (NSP), as well as its impact on mortality.
METHODS: We looked at patients < 18 years of age delivered directly from the scene in the 2016 National Trauma Quality Improvement Program Database. NSP has previously been defined as: transfusion of blood products, immediate operating room for hemorrhage control or craniotomy, vasopressors, interventional radiology upon arrival, spinal cord injury suspected, tube thoracostomy upon arrival, emergency department thoracotomy, intracranial pressure monitor, and pericardiocentesis. We evaluated early intubation and its relation to other NSP factors and mortality.
RESULTS: A total of 2003 patients < 18 years of age were intubated at the scene or in the emergency department. 873 (44%) had at least one NSP factor, and 491 (56%) of these had 2 or more additional NSP factors. The most common NSP factors associated with early intubation were: transfusion, 611 (31%), ICP monitor, 331 (17%), hemorrhage control operation, 295 (15%), and chest tube, 197 (10%). Patients intubated early, with at least one additional NSP factor had 6.2 (95%CI=4.5-8.5) times higher odds of dying than intubation alone.
CONCLUSION: Intubated pediatric trauma patients have an additional NSP factor nearly half the time, and increased mortality, further validating early intubation as a minimum ACS criteria for full team activation.
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