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Early Intubation of Injured Children with Altered Mental Status

James A Meltzer1, Anna Liveris2, Stephen M Blumberg1

  • 1Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, New York.

The Journal of Emergency Medicine
|September 17, 2025
PubMed

Insights

Early intubation for injured children with a Glasgow Coma Scale (GCS) of ≤8 did not reduce mortality or poor outcomes. This study suggests current guidelines may need reevaluation for pediatric trauma patients.

Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Clinical Outcomes Research

Background:

  • Current resuscitation guidelines recommend early intubation for trauma patients with Glasgow Coma Scale (GCS) ≤8.
  • Evidence supporting this recommendation, especially in pediatric populations, is limited.

Purpose of the Study:

  • To investigate whether early intubation in injured children (GCS ≤8) admitted to the Emergency Department (ED) is associated with reduced morbidity and mortality.
  • To compare outcomes between children intubated within 1 hour of ED arrival versus those intubated later.

Main Methods:

  • Retrospective analysis of injured children (<18 years) with GCS ≤8 from the National Trauma Data Bank (2017-2021).
  • Patients were categorized by intubation timing: early (within 1 hour of ED arrival) vs. not early.
  • Propensity score inverse probability weighting was employed to control for confounding factors.

Main Results:

  • No significant difference in 24-hour mortality or risk of poor functional outcome was observed between early and late intubation groups.
  • Early intubation was associated with a small but statistically significant increase in 30-day mortality risk.
  • The study analyzed 6698 eligible patients from a larger cohort of 25,355.

Conclusions:

  • The findings challenge the universal recommendation for early intubation in all injured children with a GCS score of ≤8.
  • Further research is needed to refine intubation protocols for pediatric trauma patients based on specific clinical factors.
Abstract

Keywords:
Glasgow Coma ScaleTRAUMAaltered mental statuschildreninjuryintubationpediatric

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