Early Intubation of Injured Children with Altered Mental Status

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-07-04 DOI:10.1016/j.jemermed.2025.07.003

James A. Meltzer MD MS , Anna Liveris MD , Stephen M. Blumberg MD , Srinivas H. Reddy MD

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引用次数: 0

Abstract

Background

Emergency resuscitation guidelines recommend early intubation for injured patients with a Glasgow Coma Scale (GCS) score of ≤8. Supportive research is lacking, particularly in children.

Objective

To determine if injured children with a GCS of ≤8 who are intubated early after Emergency Department (ED) arrival have a lower morbidity and mortality when compared to those that are not.

Methods

This was a retrospective study of injured children <18 years with a GCS ≤8 from the National Trauma Data Bank (2017 to 2021). Patients were classified as receiving early intubation if they were intubated within 1 hour of ED arrival. The main outcomes were 24-hour and 30-day mortality as well as poor functional outcome. To adjust for potential confounding, propensity score inverse probability weighting was used.

Results

Of the 25,355 injured children with a GCS ≤8, 6698 patients were eligible for analysis. The median age was 14 years (IQR 6, 16) and 4579 (68%) were male. A total of 4883 (73%) were intubated in the first hour of arrival to the ED. After propensity score weighting, we found no significant difference in 24-hour mortality (adjusted risk difference [ARD], 0.1% [95% CI: −2.0, 2.3]) or risk of poor functional outcome (ARD, 2.6% [95% CI: −0.2, 5.5]), between those who were intubated in the first hour compared to those who were not. Patients who were intubated in the first hour had a small but significantly higher 30-day mortality risk (ARD, 3.1% [95% CI: 0.7, 5.4]).

Conclusion

This study questions the guidance that all injured children with GCS ≤8 should be intubated upon arrival.

查看原文本刊更多论文

精神状态改变的受伤儿童早期插管治疗。

背景：急诊复苏指南建议格拉斯哥昏迷评分(GCS)≤8分的受伤患者早期插管。缺乏支持性研究，特别是在儿童方面。目的：确定GCS≤8的受伤儿童在急诊科（ED）到达后早期插管是否比未插管的儿童有更低的发病率和死亡率。方法：对受伤儿童进行回顾性研究。结果：在25,355例GCS≤8的受伤儿童中，有6698例患者符合分析条件。中位年龄为14岁（IQR为6.16），男性4579例（68%）。共有4883例（73%）患者在到达急诊室的第一个小时内插管。在倾向评分加权后，我们发现在第一个小时插管的患者与未插管的患者在24小时死亡率（校正风险差[ARD]， 0.1% [95% CI: -2.0, 2.3]）或功能不良结局风险（ARD, 2.6% [95% CI: -0.2, 5.5]）方面没有显著差异。在第一个小时插管的患者30天死亡风险虽小但明显较高（ARD, 3.1% [95% CI: 0.7, 5.4]）。结论：本研究质疑了所有GCS≤8的受伤儿童到达时都应插管的指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine