Abstract: Objective To evaluate of the different effects of pre-hospital endotracheal intubation and hospital intubation on the prognosis of patients with severe traumatic brain injury. Methods Literatures of the effect of pre-hospital endotracheal intubation on the prognosis of patients with severe traumatic brain injury were collected from PubMed, EMbase, Ovid, Cochrane Library, CNKI, CBM, Wanfang Data and VIP database from the inception till December 2017 and the references of related literatures were collected as well. Two researchers screened publications independently and methodology quality of the included references was evaluated. Meta-analysis was performed by using RevMan 5.3 software and Stata 12.0 software was used for sensitivity analysis and funnel chart was created for the publication bias of the literatures. Results Eight studies involving 17,604 patients were finally included. The results of meta-analysis showed that the mortality[RR=1.15,95%CI(1.09~1.20), P<0.00001] and ICU length of stay[SMD=0.56,95%CI (0.12~1.00),P=0.01] of patients with severe traumatic brain injury were increased after pre-hospital tracheal intubation when compared with those after hospital intubation, but pre-hospital tracheal intubation exerted no effect on the incidence of pneumonia[RR=1.28,95%CI(0.95~1.71),P=0.10] and duration of mechanical ventilation [SMD=0.15,95%CI(-0.08~0.37),P=0.20]. Sensitivity analysis showed that the results were stable, and no obvious bias was found in the test of publication bias. Conclusion Pre-hospital endotracheal intubation in patients with severe traumatic brain injury may increase the mortality and prolong the duration of ICU length of stay, but has no significant effect on the incidence of pneumonia and the duration of mechanical ventilation. However, more quality RCTs are needed to confirm the conclusion .

Key words: traumatic brain injury, endotracheal intubation, pre-hospital emergency care, the prognosis, Meta-analysis