Methods: This propensity matched, retrospective study utilizing the TriNetX database was performed using information extracted from approximately 105 million patients from 61 healthcare organization within the United States between December 22, 2003, and October 22, 2022. Patients were included if they were ≤ 17 years old, were intubated on the same day as an emergency visit and given etomidate or ketamine as a part of rapid sequence intubation along with paralytics (succinylcholine or rocuronium). The outcomes evaluated were mortality and adrenal insufficiency within 60 days after the intubation. Patients were excluded from the analysis if they had a prior history of adrenal insufficiency. Propensity matching was performed for demographics and seven pre-existing conditions associated with mortality.

Results: Before propensity matching, there were 1,228 in the etomidate group and 643 in the ketamine group for a total cohort of 1,871 children. The final cohort included 1,130 patients evenly divided between groups after propensity matching. There was no difference in mortality between groups before (RR=1.03, 95% CI 0.79-1.36, p=.81) and after (RR=0.95, 95% CI 0.67-1.35, p=.78) propensity matching. There was a significantly lower risk of adrenal insufficiency for the etomidate group when compared to the ketamine group before (0.80% vs 4.10%, RR=0.20, 95% CI 0.10-0.40, p

Donna Mendez is a board certified Pediatrician as well as Pediatric Emergency Medicine Physician. She completed her pediatric residency at the University of Texas Health Science Center (UTHSC) in San Antonio, and a fellowship in Pediatric Emergency Medicine at University of Texas Southwestern in Dallas. She is the Director of the Pediatric Emergency Medicine fellowship. Her research focus is on head injury and medical education. Dr. Mendez is currently investigating Fast MRI for ventriculoperitoneal shunt malfunction. She is a HRSA grant reviewer and reviewer for Journal of Trauma, Pediatrics, and Journal of Advances in Health Sciences Education Reviewer. She has received her certificate in Medical Education Research and is presently obtaining her Doctorate in Professional Leadership with an emphasis in Health Science Education from the University of Houston.