The Effect of Prehospital Intubation on Treatment Times in Patients With Suspected Traumatic Brain Injury

• Prehospital intubation (PHI) was compared with in-hospital intubation in patients with traumatic brain injury.
• PHI is associated with decreased time from emergency department arrival to computed tomographic scanning but a longer scene time.
• Many patients undergoing PHI have an initial Glasgow Coma Score of 3 and undetectable blood pressure.

ObjectiveThis study examines whether, in patients requiring intubation with moderate to severe traumatic brain injury (TBI), prehospital intubation compared with emergency department intubation leads to a reduction in treatment times and time to a computed tomographic (CT) scan.MethodsA retrospective cohort study compared adult patients with a Glasgow Coma Score of less than 14 with a suspected TBI who underwent intubation, either prehospital or on arrival to the emergency department.ResultsPrehospital intubation was associated with a decreased time from emergency department arrival to CT scan compared with emergency department intubation (43 vs. 54 minutes, P < .001). The prehospital intubation group had a longer median scene time (42 vs. 17 minutes, P ≤ .001), longer median transport times (32 vs. 14 minutes, P ≤ .001), and longer total treatment times (90 vs. 73 minutes, P = .007).ConclusionsPatients intubated in the prehospital setting spend a longer time at the scene but a shorter amount of time in the emergency department before brain imaging. Prehospital intubation may lead to earlier control of airway and ventilation. The minority of intubated TBI patients required urgent neurosurgical intervention. Overall prehospital intubation shows no significant survival advantage for the patients when compared with emergency department intubation.