R. B. Hawkins1, S. L. Raymond1, H. C. Hamann1, M. M. Mustafa1, J. A. Taylor1, S. Islam1, S. D. Larson1 1University Of Florida,Department Of Surgery, Division Of Pediatric Surgery,Gainesville, FL, USA
Introduction: Trauma is the leading cause of death in pediatric patients over 1 year of age. Controversy exists regarding prehospital airway management for these patients. Studies suggest that bag-valve mask ventilation is preferred in an urban setting. The purpose of this study is to evaluate differential outcomes in pediatric trauma patients who underwent endotracheal intubation at the scene of injury, referring hospital, or pediatric trauma center in a predominantly rural/suburban setting.
Methods: A retrospective review was performed evaluating trauma patients age 18 or younger at a single institution over 10 years (2004-2014). Patients were selected who underwent endotracheal intubation and were classified based on location of intubation (scene, referring hospital, or trauma center). Fischer’s exact test and t-tests were performed to compare outcomes between groups, and multivariate regression modeling was performed to evaluate for significant predictors of mortality.
Results: 288 patients were identified who underwent endotracheal intubation related to their trauma care. 155 (53.8%) were intubated at the scene of injury, 55 (19.1%) at a referring hospital, and 72 (25%) at the trauma center. Overall mortality was 21.9%, which was highest in the scene intubation group (29.7%) compared to the referring hospital (20%) and trauma center (5.6%) groups (p<0.01). Patients intubated at the scene had higher Injury Severity Scores and lower Glasgow Coma Scale scores (p<0.01). Duration of intubation was lowest in the trauma center group (p<0.01). Complication rate was highest in the referring hospital group (p<0.05). A multivariate regression model identified location of intubation, ISS, and GCS as significant independent predictors of mortality with an area-under-the-curve of 0.9193.
Conclusion: Mortality and duration of intubation were lowest in trauma patients intubated at a pediatric trauma center. When possible, intubation can be delayed as indicated until expert care can be provided at a pediatric trauma center in a rural/suburban setting.
