Observed versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores < 9
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A Glasgow Coma Scale (GCS) score of 8 or less in patients suffering from severe traumatic brain injury (TBI) represents a decision-making marker in terms of intubation. This study evaluated the impact of prehospital intubation on the mortality of these TBI cases among different age groups.
This study included the data from patients predominantly suffering from severe TBI [Abbreviated Injury Scale (AIS) of the head ≥ 3, GCS score < 9, Injury Severity Score (ISS) > 9] who were registered in TraumaRegister DGU® from 2002 to 2013. An age-related analysis of five subgroups was performed (1–6, 7–15, 16–55, 56–79, and ≥ 80 years old). The observed and expected mortality were matched according to the Revised Injury Severity Classification, version II.
A total of 21,242 patients were included. More often, the intubated patients were severely injured when compared to the non-intubated patients (median ISS 29, IQR 22–41 vs. 24, IQR 16–29, respectively), with an associated higher mortality (42.2% vs. 30.0%, respectively). When compared to the calculated expected mortality, the observed mortality was significantly higher among the intubated patients within the youngest subgroup (42.2% vs. 33.4%, respectively; p = 0.03).
The observed mortality in the intubated children 1–6 years old suffering from severe TBI seemed to be higher than expected. Whether or not a GCS score of 8 or less is the only reliable criterion for intubation in this age group should be investigated in further trials.
KeywordsGlasgow Coma Scale Intubation Pediatric Prehospital Traumatic brain injury
Compliance with ethical standards
Conflict of interest
Rolf Lefering’s Institute (IFOM) has a service agreement with the AUC GmbH who is the owner of the TraumaRegister DGU. This includes support in data analysis for scientific publications. All other authors declare that they have no conflict of interest.
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