Basic is Better? An Assessment of National Outcomes in Prehospital Airway Management in Critical Acuity Pediatric Trauma.

Abstract

Background: Consensus is lacking regarding prehospital airway management in pediatric trauma patients (PTPs).

Objectives: This retrospective study compared prehospital basic-airway procedures (B-AP) vs. advanced-AP (A-AP) among PTPs, comparing scene time, transport time, and improvement in acuity from scene to emergency department.

Methods: The 2020 National Emergency Medical Services Information System was used to study patients 1-18 years old with prehospital AP. A-AP were compared with B-AP using chi-square, Wilcoxon rank sum, multivariable logistic, and linear regression models in terms of improvement in acuity, and transport and scene times.

Results: The 3325 cases included 672 A-AP and 2653 B-AP; 39 esophageal combi- or dual lumen tubes, 48 laryngeal mask airways, and 585 orotracheal intubations. Overall failure rate: A-AP 8.77% vs B-AP 1.09% (p < 0.0001). Adjusted models identified reduction in scene time for B-AP vs. A-AP (estimate: 4 min 51 s, 95% confidence interval 9 min, 49 s-6 s; p = 0.01). B-APs were associated with improved acuity (odds ratio 1.19, 95% confidence interval 1.11-1.27; p < 0.001) after adjusting for Revised Trauma Score, provider type, urbanicity, time spent at scene, and demographic variables.

Conclusion: Prehospital B-APs were associated with shorter scene time and improvement in acuity compared with A-AP in PTPs. Variability in airway management practices across U.S. regions is high, leaving room for improvement in standardization of care and training.