Clinical and Laboratory Markers to Predict the Need for Intubation in Pediatric Trauma

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Objective: Emergency tracheal intubation is a critical component of acute management in children with traumatic injuries. This study aimed to determine which clinical and laboratory markers are most predictive of the need for airway intervention in this vulnerable population. Materials and Methods: This observational cohort analysis included 96 pediatric trauma patients under 18 years of age admitted to a university hospital Pediatric Intensive Care Unit (PICU). Demographic data, trauma characteristics, clinical parameters, and laboratory markers were analyzed. Statistical analyses included logistic regression and receiver operating characteristic (ROC) analysis to identify predictors of intubation. Results: Among the 96 pediatric trauma patients, 45.8% required intubation. Female patients had significantly higher intubation rates (45.5%) compared to males (36.9%) (p=0.011). Trauma etiology differed significantly, with traffic accidents being more common among intubated patients, while falls from height were more frequent in non-intubated patients (p=0.007). Patients with multiple system injuries had an increased likelihood of intubation (p=0.004). Intubated patients had markedly higher blood glucose level, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin, international normalized ratio (INR), and lactate levels, while platelet counts were significantly decreased (p<0.001, p=0.036, p=0.039, p=0.026, p=0.002, p=0.007, p=0.003, and p=0.031, respectively). Logistic regression identified female sex, elevated blood glucose, decreased platelet count, and blood transfusion requirement as independent predictors. Intubated patients had significantly longer PICU stays (7.0 vs. 3.0 days, p<0.001) and overall hospital stays (14.5 vs. 7.0 days, p<0.001). Conclusion: Female sex, motor vehicle accidents, drowning, and multisystem trauma were significantly associated with an increased risk of intubation. Key laboratory predictors included elevated blood glucose levels, decreased platelet count, and the need for blood transfusion. These markers can help guide early airway management decisions in pediatric trauma care.