Gravesteijn BY, Sewalt CA, Ercole A, et al. - Researchers investigated the current intubation practice in Europe after traumatic brain injury. In addition, they sought for variation in practice. From the prospective cohort study collaborative European neurotrauma effectiveness research in traumatic brain injury in 45 centres in 16 European countries, they included a total of 3,843 patients. Tracheal intubation was done in 1,322 (34%) of these patients; 839 (22%) underwent prehospital intubation and 483 (13%) underwent in-hospital intubation. The fit of the model with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). Increased likelihood of tracheal intubation was observed in correlation with the following factors: younger age; lower prehospital or emergency department GCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviated injury score); and one or more unreactive pupils. More prehospital intubations were observed in independent correlation with the presence of an anesthetist in contrast to the presence of ambulance personnel who are allowed to intubate. Findings thereby suggest that tracheal intubation is mainly driven by patient and injury characteristics. Further, there were substantial variations in tracheal intubation practice between centers and countries in Europe.