Epidemiology, Prehospital Characteristics and Outcomes of Severe Traumatic Brain Injury in The Netherlands: The BRAIN-PROTECT Study

Bossers, Sebastiaan M.; Boer, Christa; Bloemers, Frank W.; Lieshout, Esther M.M. Van; Hartog, Dennis den; Hoogerwerf, Nico; Innemee, Gerard; Naalt, Joukje van der; Absalom, Anthony; Peerdeman, Saskia M.; Visser, Matthijs de; Leeuw, Marcel A. de; Schwarte, Lothar A.; Loer, Stephan A.; Schober, Patrick

doi:10.1080/10903127.2020.1824049

Cited by 20 publications

(18 citation statements)

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“…Data even suggest that prehospital TXA was often given in patients with TBI since patients who received prehospital TXA had higher AIShead, were more often prehospitally intubated and had higher PaCO2 with similar pH in ED (suggestive for prehospital hypoventilation) than patients who did not receive prehospital TXA. Several studies have reported various effects of TXA on outcome in TBI from depending on brain injury severity and timing of TXA administration [26] to no difference in outcome after prehospital TXA [27], or even a potential harmful effect of prehospital TXA on mortality in severe TBI patients [28]. The effect of TXA on TBI in this polytrauma population was beyond the scope of this paper.…”

Section: Discussionmentioning

confidence: 99%

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Wessem

Leenen

2021

World j. surg.

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Background Early hemorrhage control is important in trauma-related death prevention. Tranexamic acid (TXA) has shown to be beneficial in patients in hemorrhagic shock, although widespread adoption might result in incorrect TXA administration leading to increased morbidity and mortality. Methods A 7-year prospective cohort study with consecutive trauma patients admitted to a Level-1 Trauma Center ICU was performed to investigate administration of both pre- and in-hospital TXA and its relation to morbidity and mortality. Indication for prehospital and in-hospital TXA administration was (suspicion of) hemorrhagic shock, and/or systolic blood pressure (SBP) ≤ 90 mmHg. Demographics, data on physiology, resuscitation and outcomes were prospectively collected. Results Four hundred and twenty-two patients (71% males, median ISS 29, 95% blunt injuries) were included. Even though TXA patients were more severely injured with more deranged physiology, no differences in outcome were noted. Overall, thrombo-embolic complication rate was 8%. In half the patients, hemorrhagic shock was the indication for prehospital TXA, whereas 79% of in-hospital TXA was given based on suspicion of hemorrhagic shock. Thirteen percent of patients with SBP ≤ 90 mmHg in ED received no TXA at all. Based on SBP alone, 22% of prehospital TXA and 25% of in-hospital TXA were justified. Conclusions Despite being more severely injured, TXA patients had similar outcome compared to patients without TXA. Thrombo-embolic complication rate was low despite liberal use of both prehospital and in-hospital TXA. Caution should be exercised in selecting patients for TXA, although this might be challenging based on SBP alone in patients who do not yet show signs of deranged physiology on arrival in ED.

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Section: Discussionmentioning

confidence: 99%

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Wessem

Leenen

2021

World j. surg.

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“…After unadjusted logistic regression analyses, a multivariable model was built to account for potential confounders, including confounding by indication . Control variables were all simultaneously added to the model according to theoretical considerations and previous literature and included demographic factors (ie, age and sex), preinjury medical condition and medications (ie, American Society of Anesthesiologists Physical Status Classification System score and use of anticoagulant drugs), injury characteristics and severity (ie, trauma mechanism, Injury Severity Score [score range: 1-75, with the highest score indicating critical injury in at least 3 body regions or any unsurvivable injury], and initial GCS score [score range: 3-15, with the highest score indicating that the patient opens the eyes spontaneously, is oriented, and obeys commands]), operational characteristics (ie, involved HEMS provider and distance from the accident scene to the trauma center), and first recorded vital parameters at arrival of HEMS (ie, systolic blood pressure, heart rate, and oxygen saturation as measured by pulse oximetry). Numerical independent variables were modeled using restricted cubic splines to relax the assumption of a linear association between the variable and the logit of mortality.…”

Section: Methodsmentioning

confidence: 99%

Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury

et al. 2021

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IMPORTANCEThe development and expansion of intracranial hematoma are associated with adverse outcomes. Use of tranexamic acid might limit intracranial hematoma formation, but its association with outcomes of severe traumatic brain injury (TBI) is unclear.OBJECTIVE To assess whether prehospital administration of tranexamic acid is associated with mortality and functional outcomes in a group of patients with severe TBI. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study is an analysis of prospectively collected observational data from the Brain Injury: Prehospital Registry of Outcome, Treatments and Epidemiology of Cerebral Trauma (BRAIN-PROTECT) study in the Netherlands. Patients treated for suspected severe TBI by the Dutch Helicopter Emergency Medical Services between February 2012 and December 2017 were included. Patients were followed up for 1 year after inclusion. Data were analyzed from January 10, 2020, to September 10, 2020.EXPOSURES Administration of tranexamic acid during prehospital treatment. MAIN OUTCOMES AND MEASURESThe primary outcome was 30-day mortality. Secondary outcomes included mortality at 1 year, functional neurological recovery at discharge (measured by Glasgow Outcome Scale), and length of hospital stay. Data were also collected on demographic factors, preinjury medical condition, injury characteristics, operational characteristics, and prehospital vital parameters.RESULTS A total of 1827 patients were analyzed, of whom 1283 (70%) were male individuals and the median (interquartile range) age was 45 (23-65) years. In the unadjusted analysis, higher 30-day mortality was observed in patients who received prehospital tranexamic acid (odds ratio [OR], 1.34; 95% CI, 1.16-1.55; P < .001), compared with patients who did not receive prehospital tranexamic acid. After adjustment for confounders, no association between prehospital administration of tranexamic acid and mortality was found across the entire cohort of patients. However, a substantial increase in the odds of 30-day mortality persisted in patients with severe isolated TBI who received prehospital tranexamic acid (OR, 4.49; 95% CI, 1.57-12.87; P = .005) and after multiple imputations (OR, 2.05; 95% CI, 1.22-3.45; P = .007).CONCLUSIONS AND RELEVANCE This study found that prehospital tranexamic acid administration was associated with increased mortality in patients with isolated severe TBI, suggesting the judicious use of the drug when no evidence for extracranial hemorrhage is present.

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“…17 Furthermore, in the Netherlands more than half of the TBI patients were involved in road traffic crashes. 18 The insights into the causes, patterns, and distributions of TBI patients from this study will be extremely helpful in policymaking, research, health management, and rehabilitation at the national level in our country and other developing nations. These methods provide promises for future studies to further clarify the true epidemiology of characteristics injury of brain trauma, which in turn will guide the development of clinical endpoints for diagnostic and the outcome of studies and data collection are of great importance in TBI studies, and is crucial to advance the care for TBI patients in the future.…”

Section: Discussionmentioning

confidence: 91%

Epidemiology, Reported Injury Characteristics of Brain Trauma: Evidences Collected from a Level-One-Trauma Center in Zahedan City, Iran

Sharbafshaaer

2021

Hosp Pract Res

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Background: Traumatic brain injury (TBI) is the damage to brain tissue and disruption of the brain function caused by an external mechanical force as evidenced by documented medical records. Objectives: The study aimed to estimate the prevalence of TBI through age-groups, severity, and mechanism of TBI. Methods: This cross-sectional study contained all TBI patients who were admitted at the main level one trauma center hospital located in southeastern Iran. Results: The number of reported patients was 445 young and old adults with TBI. In total, the mean age of the patients was 32.35 ranging from 17 to >80 years. Of the studied patients 361 (81.1%) were male and 84 (18.9%) were women. The most common principal severity of TBI among patients aged 20-29 years was moderate. This corresponds with the age groups that are known to be at higher risk for three levels of TBI. Car accident multiple trauma and head trauma show severity of TBI in both genders. Conclusion:The research findings determined the lack of ignoring the traffic control system in southeastern Iran that was the main cause of the injury; consequently, the focus of all essentials in traffic management should be considered for this problem. It must be noted that the incidence of TBI is necessary as there remains no cure for mild-to-severe TBI. As the evidence for effectiveness and specific treatment is limited, it must be subjected to demanding research.

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Epidemiology, Prehospital Characteristics and Outcomes of Severe Traumatic Brain Injury in The Netherlands: The BRAIN-PROTECT Study

Abstract: A thorough understanding of the epidemiology, patient characteristics, trauma mechanisms, and current outcomes among patients with severe traumatic brain injury (TBI) is important as it may inform potential strategies to improve prehospital emergency care. The aim of this

Cited by 20 publications

References 33 publications

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

Association Between Prehospital Tranexamic Acid Administration and Outcomes of Severe Traumatic Brain Injury

Epidemiology, Reported Injury Characteristics of Brain Trauma: Evidences Collected from a Level-One-Trauma Center in Zahedan City, Iran

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