TOPLINE:

An analysis of 7.6 million trauma cases over 7 years showed that 3.7% of patients underwent emergency department (ED) endotracheal intubation (ETI), which was associated with a mortality rate of 10.2%. Head or chest injury, shock, and a low Glasgow Coma Scale (GCS) score were identified as key risk factors.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using data of 7,620,399 patients with trauma from the American College of Surgeons Trauma Quality Improvement Program databases from 2017 to 2023 and analyzed data of patients with a documented ED length of stay.
• Of these patients, 279,627 underwent ETI in the ED (mean age, 39 years; 75.8% men), whereas 7,340,772 did not (mean age, 53 years; 58.4% men).
• Most intubations occurred at level 1 verified centers, with a median time from arrival to ETI of 10.2 minutes.
• The primary outcome was 24-hour survival. Secondary outcomes included ED mortality, factors associated with ETI in the ED, and subgroup outcomes among pediatric patients (n = 815,531).

TAKEAWAY:

• The 24-hour survival rate was significantly lower in patients who were intubated than in those who were not intubated (69.8% vs 97.5%).
• Among patients who were intubated, the mortality rate in the ED was 10.2%, with a median time from intubation to death of 15.6 minutes.
• Higher odds of ED ETI were associated with male sex (odds ratio [OR], 1.40), head/neck injury (OR, 2.40), firearm injury (OR, 1.52), stabbing (OR, 1.34), shock (OR, 1.73), low GCS score (OR, 0.69), need for respiratory assistance on arrival (OR, 5.70), and emergency medical service (EMS) arrival (OR, 2.14).
• In the pediatric subgroup, 2.3% of patients underwent ED ETI. Similar factors — including male sex (OR, 1.05), collision (OR, 1.08), firearm injury (OR, 2.29), head/neck injury (OR, 3.55), low GCS score (OR, 0.69), respiratory assistance on arrival (OR, 6.51), and EMS arrival (OR, 1.90) — were associated with ED ETI. Most ED ETIs occurred at nonpediatric trauma centers, and the 24-hour survival rate was 76.1%.

IN PRACTICE:

"In this national cohort of over 7.6 million trauma encounters, 3.7% of patients underwent ED endotracheal intubation (ETI), with a median time to intubation of 10 min. "[The study] findings highlight the high-risk nature of ED ETI and the need for optimized airway and resuscitation strategies specific to trauma care," the authors wrote.

SOURCE:

The study was led by Lucia C. Lin, MD, Denver Health Residency in Emergency Medicine, Denver. It was published online on October 15, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

The study was limited by its retrospective design, which potentially introduced selection, recall, and hindsight biases. The observational nature of the study restricted findings to associations rather than causal relationships. The dataset lacked crucial procedural details, including medications used, airway equipment choice, pre-oxygenation methods, complications, and operator training level. Additionally, the complex nature of airway management decisions — encompassing both technical and physiologic factors — could not be fully captured in the available data.

DISCLOSURES:

The study did not receive any specific funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.