Effectiveness of Prehospital Use of Advanced Airway Management in Traumatic Brain Injury Patients: A Systematic Review
Bibliographic record
Abstract
Background: Traumatic brain injury (TBI) is a leading cause of trauma-related mortality and disability, necessitating rapid and effective airway management to prevent secondary brain injury. Establishing a definitive airway before hospital admission is often performed in the prehospital setting; however, its impact on patient outcomes remains debated. Objective: This study aimed to assess the effectiveness of prehospital advanced airway management in TBI patients by comparing mortality and morbidity outcomes between prehospital and in-hospital intubation. Methods: A systematic review was conducted following PRISMA guidelines. Five electronic databases were searched, and data extraction was performed using Endnote. Inclusion criteria encompassed observational studies, cohort studies, and randomized controlled trials (RCTs) evaluating prehospital intubation. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias, and statistical analysis was performed to evaluate mortality and morbidity trends. Results: Despite considerable heterogeneity, no statistically significant difference in mortality was observed between prehospital and in-hospital intubation (OR = 1.08, 95% CI: 0.89–1.27, p = 0.32). However, sensitivity analysis suggested a 12% reduction in morbidity with prehospital intubation (RR = 0.88, 95% CI: 0.79–0.96), particularly when performed by trained professionals following standardized protocols. Studies incorporating rapid sequence intubation (RSI) and capnography monitoring reported improved neurological outcomes, with a 15–20% increase in favorable Glasgow Outcome Scale (GOS) scores compared to non-RSI approaches. Variability in intervention techniques, prolonged on-scene times, and inconsistent ventilation management contributed to conflicting findings, underscoring the necessity of cautious interpretation due to data variability. Conclusion: While prehospital intubation remains a critical intervention in TBI management, its superiority over in-hospital intubation remains uncertain. Standardized protocols, RSI implementation, provider training, and further high-quality RCTs are essential to establish its clinical efficacy and optimize patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.046 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.009 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".