The current German S3 guideline for polytrauma lists five criteria for prehospital intubation: apnea, severe traumatic brain injury (GCS ≤8), severe chest trauma with respiratory failure, hypoxia, and persistent hemodynamic instability. These guideline criteria, used in adults in daily practice, have not been previously studied in a collection of severely injured children. The aim of this study was to assess the extent to which the criteria are implemented in clinical practice using a multivariate risk analysis of severely injured children. Data of 289,698 patients from the TraumaRegister DGU® were analyzed. Children meeting the following criteria were included: Maximum Abbreviated Injury Scale 3+, primary admission, German-speaking countries, years 2008–2017, and declaration of intubation. Since children show age-dependent deviating physiology, four age groups were defined (years old: 0–2; 3–6; 7–11; 12–15). An adult collective served as a control group (age: 20–50). After a descriptive analysis in the first step, factors leading to prehospital intubation in severely injured children were analyzed with a multivariate regression analysis. A total of 4489 children met the inclusion criteria. In this cohort, young children up to 2 years old had the significantly highest injury severity (Injury Severity Score: 21; p ≤ 0.001). Falls from both high (> 3 m) and low heights (< 3 m) were more common in children than in adults. The same finding applied to the occurrence of severe traumatic brain injury. When at least one intubation criterion was formally present, the group up to 6 years old was least likely to actually be intubated (61.4%; p ≤ 0.001). Multivariate regression analysis showed that Glasgow Coma Scale score ≤ 8 in particular had the greatest influence on intubation (odds ratio: 26.9; p ≤ 0.001). The data presented here show for the first time that the existing criteria in the guideline for prehospital intubation are applied in clinical practice (approximately 70% of cases), compared to adults, in the vast majority of injured children. Although severely injured children still represent a minority of all injured patients, future guidelines should focus more on them and address them in a specialized manner.

中文翻译：

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严重受伤儿童的院前插管是否符合指南？

目前德国多发伤S3指南列出了5项院前插管标准：呼吸暂停、严重创伤性脑损伤（GCS≤8）、严重胸部创伤伴呼吸衰竭、缺氧和持续血流动力学不稳定。这些指导标准在成人的日常实践中使用，之前尚未在一组严重受伤的儿童中进行过研究。本研究的目的是通过对严重受伤儿童进行多变量风险分析来评估该标准在临床实践中的实施程度。分析了来自 TraumaRegister DGU® 的 289,698 名患者的数据。符合以下标准的儿童被纳入：最大简略伤害量表 3+、初次入院、德语国家、2008-2017 年和插管声明。由于儿童表现出与年龄相关的生理偏差，定义了四个年龄组（年龄：0-2；3-6；7-11；12-15）。一个成年集体作为对照组（年龄：20-50 岁）。在第一步进行描述性分析后，采用多元回归分析法分析导致重伤儿童院前插管的因素。共有 4489 名儿童符合纳入标准。在该队列中，2 岁以下的幼儿受伤严重程度最高（受伤严重程度评分：21；p ≤ 0.001）。从高处（> 3 m）和低处（< 3 m）跌落在儿童中比在成人中更常见。同样的发现也适用于严重创伤性脑损伤的发生。当至少正式存在一项插管标准时，6 岁以下的人群实际插管的可能性最小 (61.4%；p ≤ 0.001)。多元回归分析表明，格拉斯哥昏迷量表评分≤ 8 对插管的影响最大（比值比：26.9；p ≤ 0.001）。此处提供的数据首次表明，与成人相比，绝大多数受伤儿童在临床实践中应用了院前插管指南中的现有标准（约 70% 的病例）。尽管受重伤的儿童在所有受伤患者中仍然占少数，但未来的指南应该更多地关注他们并以专门的方式解决他们。此处提供的数据首次表明，与成人相比，绝大多数受伤儿童在临床实践中应用了院前插管指南中的现有标准（约 70% 的病例）。尽管受重伤的儿童在所有受伤患者中仍然占少数，但未来的指南应该更多地关注他们并以专门的方式解决他们。此处提供的数据首次表明，与成人相比，绝大多数受伤儿童在临床实践中应用了院前插管指南中的现有标准（约 70% 的病例）。尽管受重伤的儿童在所有受伤患者中仍然占少数，但未来的指南应该更多地关注他们并以专门的方式解决他们。