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Appears in Collections:Psychology Journal Articles
Peer Review Status: Refereed
Title: Tracheal intubation in traumatic brain injury: a multicentre prospective observational study
Author(s): Gravesteijn, Benjamin Yael
Sewalt, Charlie Aletta
Nieboer, Daan
Menon, David Krishna
Maas, Andrew
Lecky, Fiona
Klimek, Markus
Lingsma, Hester Floor
Horton, Lindsay
Wilson, Lindsay
Keywords: effectiveness
neurological outcome
tracheal intubation
traumatic brain injury
Issue Date: 31-Jul-2020
Citation: Gravesteijn BY, Sewalt CA, Nieboer D, Menon DK, Maas A, Lecky F, Klimek M, Lingsma HF, Horton L & Wilson L (2020) Tracheal intubation in traumatic brain injury: a multicentre prospective observational study. British Journal of Anaesthesia.
Abstract: Background We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting.
DOI Link: 10.1016/j.bja.2020.05.067
Rights: © 2020 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (
Notes: Output Status: Forthcoming/Available Online Lindsay Horton and Lindsay Wilson are listed in this article as part of the CENTERTBI collaborators.
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