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Robert J. Winchell, MD; David B. Hoyt, MD

Arch Surg. 1997;132(6):592-597.

Abstract
Objective
To measure the effect of prehospital endotracheal intubation on outcome in patients with severe head injury and the percentage of these patients intubated in the field under existing protocol.

Design
Retrospective case-control study.

Setting
Countywide urban trauma system.

Patients
Trauma patients with blunt injury and scene Glasgow Coma Score of 8 or less, transported by ground ambulance with advanced life support capabilities from January 1, 1991, to December 31, 1995. Severe head injury was defined as head or neck Abbreviated Injury Scale score of 4 or greater. Isolated severe head injury was defined as head or neck Abbreviated Injury Scale score of 4 or greater with no other Abbreviated Injury Scale component greater than 3. One thousand ninety-two patients met initial criteria; of these, 671 had severe head injury, and 351 had isolated severe head injury.

Interventions
None.

Main Outcome Measures
Mortality and functional status sufficient for discharge to home.

Results
Field intubation was associated with significant decreases in mortality from 36% to 26% in the full study group, from 57% to 36% in patients with severe head injury, and from 50% to 23% in patients with isolated severe head injury. Rate of discharge to home was unaffected by field intubation. Between 50% and 60% of study patients were intubated under current paramedic protocol, compared with intubation rates of 85% to 92% for similar patients transported by aeromedical teams operating under expanded indications for intubation.

Conclusions
Prehospital endotracheal intubation was associated with improved survival in patients with blunt injury and scene Glasgow Coma Score of 8 or less, especially those with severe head injury by anatomic criteria. Broadening indications for intubation by paramedical personnel has great potential to improve outcome in patients with severe head injury.

Arch Surg. 1997;132:592-597

Author Affiliations
From the Division of Trauma, Department of Surgery, University of California, San Diego.

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