• Laura F Goodman, Alice M Martino, John Schomberg, Saeed Awan, Peter Yu, Theodore Heyming, Jeffry Nahmias, Yigit S Guner, and David Gibbs.
• Department of Surgery, University of California Irvine, Irvine, California; Division of Pediatric Surgery, University of California Irvine, Irvine, California.
• J Emerg Med. 2024 Sep 3.

BackgroundConsensus is lacking regarding prehospital airway management in pediatric trauma patients (PTPs).ObjectivesThis 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.MethodsThe 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.ResultsThe 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.ConclusionPrehospital 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.Copyright © 2024. Published by Elsevier Inc.

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