BackgroundConsensus is lacking regarding prehospital airway management in pediatric trauma patients (PTPs). ObjectivesThis retrospective study compared prehospital basic-airway procedures (B-AP) versus advanced-AP (A-AP) among PTPs, comparing scene time, transport time and improvement in acuity from scene to emergency department. MethodsThe 2020 National Emergency Medical Services Information System was used to study patients 1-18 years-old with pre-hospital AP. A-AP were compared with B-AP using Chi2, Wilcoxon rank sum, multivariable logistic and linear regression models in terms of improvement in acuity, and transport and scene times. Results3325 cases included 672 A-AP and 2653 B-AP; 39 esophageal combi- or dual lumen tubes, 48 LMA, and 585 orotracheal intubations. Overall failure rate: A-AP 8.77% vs B-AP 1.09% (p<0.0001). Adjusted models identified reduction in scene time for B-AP vs. A-AP (estimate: 4 minutes 51 seconds, 95% CI 9 minutes 49 seconds - 6 seconds; p= 0.01). B-AP were associated with improved acuity (OR 1.19, 95% CI 1.11-1.27; p< 0.001) after adjusting for revised trauma score, provider type, urbanicity, time spent at scene, and demographic variables. ConclusionPrehospital B-AP were associated with shorter scene time and improvement in acuity compared to A-AP in PTPs. Variability in airway management practices across US regions is high, leaving room for improvement in standardization of care and training.