Related Experiment Videos
Intubation and survival in severe paediatric blunt head injury
P Suominen1, C Baillie, A Kivioja
1Department of Paediatric Anaesthesia and Intensive Care, Hospital for Children and Adolescents, University of Helsinki, Finland.
Insights
Emergency intubation for severe childhood head injuries has high mortality. Field intubation may improve survival in pediatric trauma patients compared to delayed intubation in emergency rooms.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Critical Care
Background:
- Severe childhood injuries frequently involve head trauma.
- Emergency airway management is critical for pediatric trauma patients.
Purpose of the Study:
- To evaluate the impact of emergency intubation timing on outcomes in children with severe blunt head trauma.
- To compare survival rates between field intubation and emergency room intubation in pediatric trauma.
Main Methods:
- Retrospective analysis of 176 children (<16 years) with severe blunt head trauma (AIS > or =4) over 10 years.
- Analysis of 59 children who required intensive care or died, focusing on emergency intubation at the scene or in emergency rooms.
- Comparison of mortality and injury severity scores (AIS, ISS, GCS) based on intubation location.
Main Results:
- Overall mortality was 54.2% (32/59).
- Mortality was highest in children intubated in regional hospital ERs or in the field.
- Field-intubated children showed better survival than those intubated in regional hospital ERs, despite similar trauma scores.
Conclusions:
- Children with severe head injuries requiring emergency intubation have a high mortality rate.
- Field intubation may improve survival in pediatric trauma patients compared to delayed intubation.
- Optimal airway management is crucial for improving outcomes in severe pediatric head trauma.
Abstract:
The majority of severe childhood injuries are due to head injuries. We studied the impact of emergency intubation in a cohort of children suffering severe blunt head trauma. A 10-year retrospective case note analysis was performed on 176 children (age < 16 years) with severe blunt head trauma (abbreviated injury scale > or =4) in Southern Finland, who required intensive care in a level 1 trauma centre, or who died despite initiation of life supporting measures at the scene. Children in whom emergency intubation was performed either at the scene, or in the emergency room (ER) were analysed. Of the 59 children who fulfilled the study criteria, 20 had an isolated head injury. Most injuries (56/59) were caused by road traffic accidents. Field-intubation was performed in 24 children, and emergency intubation in the ERs of regional hospitals or the level 1 trauma centre, in 13 and 22 children respectively. Mortality was 54.2% (32/59), and was highest in children intubated in regional hospital ERs or in the field. Children intubated at the scene or in the ER of regional hospitals, had significantly worse AIS (head/neck), injury severity score (ISS), and Glasgow coma (GCS) scores than those children intubated in the ER of the level 1 trauma centre. Survival was better in field-intubated children compared with those intubated in regional hospital ERs, despite similar trauma scores (p = 0.05). It is concluded that although children with severe (AIS > or =4) head injury who require emergency intubation have a high overall mortality, field-intubation may improve survival, compared with 'scoop and run' with BLS airway management and deferred emergency intubation.