Related Experiment Video

Updated: Jan 30, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

18.5K

Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores < 9

Pedram Emami1, Patrick Czorlich2, Friederike S Fritzsche2

  • 1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246, Hamburg, Germany. p.emami@uke.de.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|January 12, 2019
PubMed

Insights

Prehospital intubation for severe traumatic brain injury (TBI) in children aged 1-6 years showed higher mortality than expected. Further research is needed to determine if a Glasgow Coma Scale score of 8 or less is the sole criterion for intubation in this vulnerable group.

Area of Science:

  • Emergency Medicine
  • Neurosurgery
  • Pediatric Critical Care

Background:

  • A Glasgow Coma Scale (GCS) score ≤ 8 is a critical indicator for intubation in severe traumatic brain injury (TBI).
  • The impact of prehospital intubation on mortality in TBI patients varies across different age groups.
  • Understanding age-specific outcomes is crucial for refining TBI management protocols.

Purpose of the Study:

  • To evaluate the effect of prehospital intubation on mortality in severe TBI patients.
  • To analyze these effects across distinct age subgroups, focusing on pediatric and elderly populations.
  • To compare observed mortality with expected mortality based on injury severity.

Main Methods:

  • Analysis of data from 21,242 severe TBI patients (Abbreviated Injury Scale head ≥ 3, GCS < 9, ISS > 9) from the TraumaRegister DGU® (2002-2013).
  • Stratification into five age groups: 1-6, 7-15, 16-55, 56-79, and ≥ 80 years.
  • Observed mortality was compared to expected mortality using the Revised Injury Severity Classification, version II.

Main Results:

  • Intubated patients had higher median Injury Severity Scores (ISS) and mortality rates (42.2%) compared to non-intubated patients (30.0%).
  • A significantly higher observed mortality (42.2%) than expected (33.4%) was noted in the youngest subgroup (1-6 years old) of intubated patients (p=0.03).
  • No significant difference between observed and expected mortality was found in other age groups.

Conclusions:

  • Prehospital intubation in very young children (1-6 years) with severe TBI may be associated with increased mortality.
  • The GCS score of 8 or less may not be the sole reliable criterion for intubation in this specific pediatric age group.
  • Further clinical trials are warranted to investigate optimal intubation criteria for severe TBI in young children.
Abstract

Keywords:
Glasgow Coma ScaleIntubationPediatricPrehospitalTraumatic brain injury

More Related Videos

SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients11:05

SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients

Published on: February 6, 2021

16.8K
Z-Scores for Assessing Ovarian Reserve in Young Patients Undergoing Fertility Preservation05:42

Z-Scores for Assessing Ovarian Reserve in Young Patients Undergoing Fertility Preservation

Published on: October 25, 2024

1.6K

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
259
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
304
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
223
Expected Value01:15

Expected Value

The expected value is known as the "long-term" average or mean. This means that over the long term of experimenting over and over, you would expect this average. The expected average is represented by the symbol μ. It is calculated as follows:
7.8K
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
292
Naturalistic Observations02:30

Naturalistic Observations

If you want to understand how behavior occurs, one of the best ways to gain information is to simply observe the behavior in its natural context. However, people might change their behavior in unexpected ways if they know they are being observed. How do researchers obtain accurate information when people tend to hide their natural behavior? As an example, imagine that your professor asks everyone in your class to raise their hand if they always wash their hands after using the restroom. Chances...
17.1K