Dr. Zubair AhmedNAIF SULHI SALEH ALQURASHI2022-05-292022-05-29https://drepo.sdl.edu.sa/handle/20.500.14154/45746Background Secondary brain injury tends to occur early after the traumatic brain injury. The aim of prehospital care is to minimize the effects of this event by providing the care required and rapidly transport the patient to a major trauma centre. Prehospital endotracheal intubation is a critical aspect of care for this type of injury. The aim of this systematic review is to evaluate the existing evidence for performing intubation in the prehospital setting for moderate to severe traumatic brain injury. Methods An electronic database search (Medline, CINAHL, EMBASE and Cochrane) was conducted to identify relevant studies. Reference lists were also searched for further relevant articles. Studies that reported the mortality and neurological functions in those who suffered a traumatic brain injury and received prehospital endotracheal intubation were included. A narrative synthesis and meta-analysis were undertaken. Results The search strategy identified 912 articles, of which 868 studies were excluded. Twelve studies met the inclusion criteria and were comprised in this systematic review. Eleven of these twelve studies were included in the subgroup meta-analysis where only the mortality outcome was quantitatively analysed. For the prehospital intubation group vs emergency department group, the pooled effects risk ratio was found to be 2.18 with a 95% CI of [1.36; 3.50], whereas for the prehospital intubation group vs non-prehospital intubation group, the pooled effect size was slightly lower with a risk ratio of 1.36 and a 95% CI of [0.77; 2.41]. There was significant heterogeneity within both subgroups. Conclusion The findings indicate that prehospital intubation is associated with increased mortality and poor neurological functions in patients with moderate to severe traumatic brain injury. However, due to the high level of heterogeneity, further research with a high-quality level of evidence is required to evaluate this intervention in the event of traumatic brain injury.en