Prehospital endotracheal intubation in patients with severe traumatic brain injury: Guidelines versus reality

Effect of Secondary Prehospital Risk Factors on Outcome in Severe Traumatic Brain Injury in the Context of Fast Access to Trauma Care

“…A recent evaluation in a Dutch urban trauma region revealed that 56% of patients with severe TBI were endotracheally intubated, whereas a substantial part of our population developed a hypoxic or hypotensive event in the prehospital period. 21 Interestingly, the rather low-intubation guideline adherence in our trauma region was associated with mortality rates comparable with the predicted and observed mortality rates reported by other registries of patients with TBI. 4,5 In this study, we therefore aim to more specifically elucidate the relationship between treatable secondary risk factors including a prehospital hypoxic or hypotensive event and absence of adherence to the intubation guideline with outcome in patients with severe TBI in a population with fast access to specialized trauma care.…”

A prospective survey of critical care procedures performed by physicians in helicopter emergency medical service: is clinical exposure enough to stay proficient?

“…In this case we speculate that attitudes of individual physicians and local culture may play a role. Previous studies have shown that even physician-staffed EMS does not always adhere to treatment guidelines indicating that individual opinions and system culture play a role in treatment strategies [9, 10]. We also know from risk assessment studies of critical procedures that culture and attitudes play a role in how critical procedures are carried out [11, 12].…”

“…We also know from risk assessment studies of critical procedures that culture and attitudes play a role in how critical procedures are carried out [11, 12]. Standard operating procedures and guidelines may explain some of the variance in how and when procedures are performed, but as a study from the Netherlands shows, even with established guidelines in place clinicians do not always adhere [9]. A risk assessment study of prehospital ETI also introduces “protocol compliance” as a factor that influences how procedures are carried out [11].…”

Haemostatic and cranial computed tomography characteristics in patients with acute and delayed coagulopathy after isolated traumatic brain injury

“…Patient data as included in the ALARM-TBI database have earlier been described in publications of Franschman et al [4,16] and Greuters et al [5]. Data were obtained with approval of the local Institutional Review Board of the VUMC.…”