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Updated: Feb 14, 2026
A Novel In Vitro Model of Blast Traumatic Brain Injury
Published on: December 21, 2018
Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: A 9-year observational study
Stefan Heschl1, Ben Meadley2, Emily Andrew2
1Medical University of Graz, Graz, Austria; Ambulance Victoria, Melbourne, Victoria, Australia.
Insights
Prehospital rapid sequence intubation (RSI) by paramedics for pediatric traumatic brain injury (TBI) showed a trend toward better outcomes. While not statistically significant, RSI may benefit major trauma patients, improving functional outcomes and reducing hospital stays.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Trauma Surgery
Background:
- Prehospital airway management for pediatric traumatic brain injury (TBI) is debated.
- Endotracheal intubation in children presents risks and benefits.
Purpose of the Study:
- To compare mortality and functional outcomes at six months.
- To evaluate prehospital rapid sequence intubation (RSI) versus no intubation in pediatric TBI patients.
Main Methods:
- Retrospective study of pediatric patients (≤14 years) with suspected TBI in Victoria, Australia.
- Comparison between helicopter transport with paramedic RSI and road ambulance without intubation.
- Data linkage for prehospital, hospital, and 6-month follow-up outcomes.
Main Results:
- High intubation success rate (99%) for paramedic-performed RSI.
- Favorable functional outcomes observed in 67% of intubated patients versus 54% of non-intubated patients.
- Prehospital RSI significantly decreased hospital stay in major trauma patients (p=0.03).
Conclusions:
- Prehospital RSI by trained paramedics is safe for pediatric TBI patients.
- A trend towards more favorable long-term outcomes was noted with prehospital intubation.
- Early intubation may benefit pediatric major trauma patients.
Introduction:
Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation.
Methods:
We conducted a retrospective study of patients aged ≤14 years with suspected TBI in Victoria, Australia. Patients were either transported via helicopter and received RSI by an ICP (2005-2013) or via road ambulance and received no intubation (2006-2013). Prehospital data was linked to hospital and 6-month follow-up data to assess mortality and functional outcome.
Results:
A total of 106 patients were included in the study of which 87 received RSI by paramedics and 19 did not receive intubation. Overall, the intubation success rate was 99% (86/87), with a first-pass success rate of 93% (81/87). In total, 67% of patients (n = 41) receiving RSI had a favourable functional outcome, compared with 54% of non-intubated patients (n = 7) (p = 0.36). In the 75 children with major trauma, prehospital RSI was associated with a significant decrease in length of hospital stay (523 h vs. 1939 h, p = 0.03). In the 53 children in this subgroup with available six months data the difference in favourable functional outcome increased to 66% (n = 31)vs. 17% (n = 1) (p = 0.06).
Discussion:
Prehospital RSI in paediatric patients with TBI can safely be performed by highly trained paramedics. Overall, we observed more favourable long-term outcomes in patients who received prehospital intubation than those who did not, however our study is not powered to detect a significant difference. Intubation prior to transport might be beneficial for major trauma patients.
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