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.