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June 7, 2000

Out-of-Hospital Endotracheal Intubation of Children

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(21):2790-2792. doi:10.1001/jama.283.21.2787

To the Editor: The study by Dr Gausche and colleagues1 is insufficient to answer the question of whether the out-of-hospital intubation of injured and ill children should remain the standard of care. Of 420 patients assigned to ETI, only 177 (42%) were actually intubated, making the ratio of BVM to intubation greater than 3:1. Intention-to-treat analysis is appropriate for clinical trials in which the aim is to show a difference. In this study, however, the authors are attempting to demonstrate equivalence of treatments. Under these circumstances, intention to treat greatly increases the chance of declaring treatments the same.2 The effectiveness of ETI in this study simply cannot be accurately assessed with such a small number of patients actually receiving the intervention. Thus, the study can only show an "absence of evidence of a difference."3