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European Journal of Trauma and Emergency Surgery

Erschienen in:

07.05.2022 | Original Article

Indications for prehospital intubation among severely injured children and the prevalence of significant traumatic brain injury among those intubated due to impaired level of consciousness

verfasst von: Nir Samuel, Yoav Hoffmann, Stav Rakedzon, Ari M. Lipsky, Aeyal Raz, Hen Ben Lulu, Hany Bahouth, Danny Epstein

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 3/2023

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Abstract

Background

Prehospital endotracheal intubation (PEI) of head injured children with impaired level of consciousness (LOC) aims to minimize secondary brain injury. However, PEI is controversial in otherwise stable children. We aimed to investigate the indications for PEI among pediatric trauma patients and the prevalence of clinically significant traumatic brain injury (csTBI) among those intubated solely due to impaired consciousness.

Methods

This is a multicenter retrospective cohort study of children who underwent PEI in northern Israel between January 2014 and December 2020 by six EMS agencies and were transported to two trauma centers in the area. We extracted data from EMS records and trauma registries.

Results

PEI was attempted in 179/986 (18.2%) patients and was successful in 92.2% of cases. Common indications for PEI were hypoxemia not corrected by supplemental oxygen (n = 30), traumatic cardiac arrest (n = 16), and facial injury compromising the airway (n = 13). 112 patients (62.6%) were intubated solely due to impaired or deteriorating LOC. Among these patients, 68 (62.4%) suffered csTBI. The prevalence of csTBI among those with field Glasgow Coma Scale (GCS) of 3, 4–8, and > 8 was 81.4%, 55.8%, and 28.6%, respectively (p < 0.001). Among children ≤ 10 years old intubated due to impaired LOC, 50% had csTBI.

Conclusion

Impaired LOC is a major indication for PEI. However, a significant proportion of these patients do not suffer csTBI. Older age and lower pre-intubation GCS are associated with more accurate field classification. Our data indicate that further investigation and better characterization of patients who may benefit from PEI is necessary.

Nur mit Berechtigung zugänglich

American College of Surgeons. Advanced Trauma Life Support for Doctors. 9th ed. Chicago: American College of Surgeons; 2012.

Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS WCAA of P-S on NSAA of NS of NSCNSES of P and NICNC. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents–second edition. Pediatr Crit Care Med. 2012;13(Suppl 1):S1-2.PubMed

Heschl S, Meadley B, Andrew E, Butt W, Bernard S, Smith K. Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: a 9-year observational study. Injury. 2018;49:916–20.PubMed

Schauer SG, Naylor JF, Hill GJ, Arana AA, Roper JL, April MD. Association of prehospital intubation with decreased survival among pediatric trauma patients in Iraq and Afghanistan. Am J Emerg Med. 2018;36:657–9.PubMed

Cooper A, DiScala C, Foltin G, Tunik M, Markenson D, Welborn C. Prehospital endotracheal intubation for severe head injury in children: a reappraisal. Semin Pediatr Surg. 2001;10:3–6.PubMed

Carlson JN, Gannon E, Clay Mann N, Jacobson KE, Dai M, Colleran C, et al. Pediatric out-of-hospital critical procedures in the United States. Pediatr Crit Care Med. 2015;16:e260–7.PubMed

Peters J, Beekers C, Eijk R, Edwards M, Hoogerwerf N. Evaluation of Dutch Helicopter Emergency Medical Services in transporting children. Air Med J. 2014;33:112–4.PubMed

Moors Xavier R, Oude Alink Michelle B, Bouman Stef J, Den Hartog D, Houmes Robert J, Stolker Robert J. Retrospective analysis of out-of-hospital paediatric intubation by a Dutch Helicopter Emergency Medical Service. Clin Pediatr Res. 2019;3:56–62.

Hansen M, Meckler G, Lambert W, Dickinson C, Dickinson K, Van Otterloo J, et al. Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS. BMJ Open. 2016;6: e012259.PubMedPubMedCentral

10.

Garner AA, Bennett N, Weatherall A, Lee A. Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis. Crit Care. 2020;24:1–15.

11.

Hansen M, Meckler G, O’Brien K, Engle P, Dickinson C, Dickinson K, et al. Pediatric airway management and prehospital patient safety: results of a National Delphi Survey by the Children’s Safety Initiative-Emergency Medical Services for Children. Pediatr Emerg Care. 2016;32:603–7.PubMedPubMedCentral

12.

Jakob DA, Lewis M, Benjamin ER, Demetriades D. Isolated traumatic brain injury: routine intubation for GCS 7 or 8 may be harmful! J Trauma Acute Care Surg. 2021;90:874–9.PubMed

13.

Von Elm E, Schoettker P, Henzi I, Osterwalder J, Walder B. Pre-hospital tracheal intubation in patients with traumatic brain injury: Systematic review of current evidence. Br J Anaesth. 2009;103:371–86.

14.

Duncan R, Thakore S. Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med. 2009;37:451–5.PubMed

15.

Samuel N, Epstein D, Oren A, Shapira S, Hoffmann Y, Friedman N, et al. Severe pediatric war trauma: a military-civilian collaboration from retrieval to repatriation. J Trauma Acute Care Surg. 2020;90:e1-6.

16.

Guinzburg A, Epstein D, Cohen J, Kiso S, Aviram E, Shapira S, et al. Emergency care provided by the Israeli Military Airborne Combat Evacuation Unit during Helicopter Winch Rescue Operations. Prehospital Emerg Care. 2020;25:397–403.

17.

Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357:1391–6.PubMed

18.

Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med. 2014;64:292–8.PubMed

19.

Acker SN, Ross JT, Partrick DA, Tong SBD. Pediatric specific shock index accurately identifies severely injured children. J Pediatr Surg. 2015;50:331–4.PubMed

20.

Yang YC, Hsieh TH, Liu CY, Chang CY, Hou YT, Lin PC, et al. Analysis of clinical outcome and predictors of mortality in pediatric trauma population: evidence from a 10 year analysis in a single center. Children. 2021;8:688.PubMedPubMedCentral

21.

Nevin DG, Green SJ, Weaver AE, Lockey DJ. An observational study of paediatric pre-hospital intubation and anaesthesia in 1933 children attended by a physician-led, pre-hospital trauma service. Resuscitation. 2014;85:189–95.PubMed

22.

Babl FE, Vinci RJ, Bauchner H, Mottley L. Pediatric pre-hospital advanced life support care in an urban setting. Pediatr Emerg Care. 2001;17:5–9.PubMed

23.

Fevang E, Perkins Z, Lockey D, Jeppesen E, Lossius HM. A systematic review and meta-analysis comparing mortality in pre-hospital tracheal intubation to emergency department intubation in trauma patients. Crit Care. 2017;21:192.PubMedPubMedCentral

24.

Wahlin RR, Nelson DW, Bellander BM, Svensson M, Helmy A, Thelin EP. Prehospital intubation and outcome in traumatic brain injury-assessing intervention efficacy in a modern trauma cohort. Front Neurol. 2018;9:194.

25.

Lockey DJ, Wilson M. Early airway management of patients with severe head injury: opportunities missed? Anaesthesia. 2020;75:7–10.PubMed

26.

Bossers SM, Boer C, Greuters S, Bloemers FW, Den Hartog D, Van Lieshout EMM, et al. Dutch prospective observational study on prehospital treatment of severe traumatic brain injury: the BRAIN-PROTECT Study Protocol. Prehosp Emerg Care. 2019;23:820–7.PubMed

27.

Boer C, Franschman G, Loer SA. Prehospital management of severe traumatic brain injury: concepts and ongoing controversies. Curr Opin Anaesthesiol. 2012;25:556–62.PubMed

28.

Emami P, Czorlich P, Fritzsche FS, Westphal M, Rueger JM, Lefering R, et al. Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores < 9. Eur J Trauma Emerg Surg. 2019;45:769–76.PubMed

29.

Epstein D, Rakedzon S, Kaplan B, Ben Lulu H, Chen J, Samuel N, et al. Prevalence of significant traumatic brain injury among patients intubated in the field due to impaired level of consciousness. Am J Emerg Med. 2021;52:159–65.PubMed

30.

Brown CVR, Inaba K, Shatz DV, Moore EE, Ciesla D, Sava JA, et al. Western Trauma Association critical decisions in trauma: Airway management in adult trauma patients. Trauma Surg Acute Care Open. 2020;5: e000539.PubMedPubMedCentral

31.

Gerritse BM, Draaisma JMT, Schalkwijk A, van Grunsven PM, Scheffer GJ. Should EMS-paramedics perform paediatric tracheal intubation in the field? Resuscitation. 2008;79:225–9.PubMed

32.

Okubo M, Komukai S, Izawa J, Gibo K, Kiyohara K, Matsuyama T, et al. Prehospital advanced airway management for paediatric patients with out-of-hospital cardiac arrest: a nationwide cohort study. Resuscitation. 2019;145:175–84.PubMed

33.

Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA. 2000;283:783–90.PubMed

34.

Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Br J Anaesth. 2005;94:150–8.PubMed

35.

Koepsell TD, Rivara FP, Vavilala MS, Wang J, Temkin N, Jaffe KM, et al. Incidence and descriptive epidemiologic features of traumatic brain injury in King County. Washington Pediatrics. 2011;128:946–54.PubMed

36.

Bankole S, Asuncion A, Ross S, Aghai Z, Nollah L, Echols HD-SS. First responder performance in pediatric trauma: a comparison with an adult cohort. Pediatr Crit Care Med. 2011;12:e166–70.PubMed

37.

Drews JD, Shi J, Papandria D, Wheeler KK, Sribnick EA, Thakkar RK. Prehospital versus trauma center glasgow coma scale in pediatric traumatic brain injury patients. J Surg Res. 2019;241:112–8.PubMed

38.

Borgialli DA, Mahajan P, Hoyle JD, Powell EC, Nadel FM, Tunik MG, et al. Performance of the pediatric Glasgow coma scale score in the evaluation of children with blunt head trauma. Acad Emerg Med. 2016;23:878–84.PubMed

39.

Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009;124:40–8.PubMed

40.

Maeyama H, Naito H, Guyette FX, Yorifuji T, Banshotani Y, Matsui D, et al. Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system. Scand J Trauma Resusc Emerg Med. 2020;28:1–8.

41.

Harrison T, Thomas SH, Wedel SK. In-flight oral endotracheal intubation. Am J Emerg Med. 1997;15:558–61.PubMed

42.

Gravesteijn BY, Sewalt CA, Ercole A, Lecky F, Menon D, Steyerberg EW, et al. Variation in the practice of tracheal intubation in Europe after traumatic brain injury: a prospective cohort study. Anaesthesia. 2020;75:45–53.PubMed

43.

Park SJ, Hur JW, Kwon KY, Rhee JJ, Lee JW, Lee HK. Time to recover consciousness in patients with diffuse axonal injury: Assessment with reference to magnetic resonance grading. J Korean Neurosurg Soc. 2009;46:205–9.PubMedPubMedCentral

Titel: Indications for prehospital intubation among severely injured children and the prevalence of significant traumatic brain injury among those intubated due to impaired level of consciousness
verfasst von: Nir Samuel
Yoav Hoffmann
Stav Rakedzon
Ari M. Lipsky
Aeyal Raz
Hen Ben Lulu
Hany Bahouth
Danny Epstein
Publikationsdatum: 07.05.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 3/2023
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-01983-2

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