Prehospital and Disaster Medicine

Original Research

Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis

Efstathios Karamanosa1 c1, Peep Talvinga1, Dimitra Skiadaa1, Melanie Osbya1, Kenji Inabaa1, Lydia Lama1, Ozgur Albuza1 and Demetrios Demetriadesa1

a1 Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA


Introduction Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant.

Hypothesis Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied.

Methods This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS).

Results Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS.

Conclusion In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.

E Karamanos, P Talving, D Skiada, M Osby, K Inaba, L Lam, O Albuz, D Demetriades. Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis. Prehosp Disaster Med. 2013;28(6):1-5 .

(Received November 20 2012)

(Accepted February 18 2013)

(Online publication December 13 2013)


  • blood gas;
  • endotracheal intubation;
  • head injury;
  • isolated;
  • prehospital


  • ABGs:arterial blood gases;
  • AIS:Abbreviated Injury Scale;
  • ED:emergency department;
  • ETI:endotracheal intubation;
  • GCS:Glasgow Coma Scale;
  • HLOS:hospital length of stay;
  • ICU LOS:intensive care unit length of stay;
  • ISS:Injury Severity Score;
  • LAC:Los Angeles County;
  • MV:mechanical ventilation;
  • TBI:traumatic brain injury;
  • USC:University of Southern California


c1 Correspondence: Efstathios Karamanos, MD University of Southern California Keck School of Medicine Department of Surgery LAC+USC Medical Center Division of Acute Care Surgery 1200 North State Street, Room 6341 Los Angeles, CA 90033 USA E-mail


  Conflicts of interest: The authors have no disclosures or conflicts of interest to report.