Table 3.
Review of literature for prehospital intubation studies in severe TBI patients.
| Authors | Definition criteria | Patient number | Overall mortality | Outcome |
|---|---|---|---|---|
| Murray et al. 2000 [7] | Severe TBI (field GCS < 8 and head AIS > 3) | 894 TBI: isolated TBI (570) | 47.2% | Prehospital intubation failed to demonstrate survival benefits in patients with severe TBI. |
| Bochicchio et al. 2003 [9] | Severe TBI (GCS score ≤ 8 and a HAIS score ≥ 3). Patients who died within 48 hours of admission were excluded | 191 TBI: isolated TBI (68) | 16.8% | PHI had significantly increased mortality (23% versus 12.4%, P = 0.05). Also, the risk of mortality was 1.85 times higher in PHI group compared to ED intubated patients. |
| Wang et al. 2004 [19] | Severe TBI (head/neck AIS ≥ 3) | 4098 | 37% | PHI is associated with increased risk of mortality (OR 3.99; 95% CI 3.21 to 4.93) and poor neurologic outcome (OR 1.61; 95% CI 1.15 to 2.26). |
| Vandromme et al. 2011 [20] | Severe TBI (prehospital GCS score ≤ 8) | 149 | 46.9% | PH intubation is associated with severe TBI but had no increased risk for mortality over ED intubation. |
| Warner et al. 2007 [21] | Severe TBI (head AIS score > 3), isolated TBI (head AIS score > 3 but no other AIS score > 2). | 187 TBI: isolated TBI (95) | 24.4% | Targeted PHI is associated with lower mortality after severe TBI. |
| Winchell and Hoyt 1997 [6] | Head AIS ≥ 4 and GCS ≤ 8 | 671 TBI: isolated TBI (351) | 57% | Field intubation reduced mortality from 57% to 36% in patients with severe TBI and from 50% to 23% in isolated TBI |
| Davis et al. 2005 [22] | Moderate to severe TBI (head/neck AIS score of ≥ 3). | 13,625 | 22.9% | PHI is associated with increased mortality (55% versus 15%) in comparison to nonintubated patients with moderate to severe TBI. |
| Present study | Field GCS ≤ 8 and head AIS ≥ 3. Patients who died within first 24 hours were excluded | 160 isolated severe TBI | 46% | No added benefit in PHI group. Scene motor GCS (OR 0.55; 95% CI 0.41–0.73) had a significant association with mortality. |
PHI: Prehospital intubations; TBI: traumatic brain injuries; GCS: Glasgow Coma Scale score; AIS: Abbreviated Injury Scale; ED: emergency department.