Prehospital Guidelines for the Management of Traumatic Brain Injury – 3rd Edition

Lulla, Al; Lumba‐Brown, Angela; Totten, Annette M; Maher, Patrick; Badjatia, Neeraj; Bell, Randy S.; Donayri, Christina T. J.; Fallat, Mary E.; Hawryluk, Gregory; Goldberg, Scott A; Hennes, Halim M.; Ignell, Steven P.; Ghajar, Jamshid; Krzyzaniak, Brian P.; Lerner, E. Brooke; Nishijima, Daniel K.; Schleien, Charles L.; Shackelford, Stacy; Swartz, Erik E.; Wright, David W.; Zhang, Rachel; Jagoda, Andy; Bobrow, Bentley J.

doi:10.1080/10903127.2023.2187905

Cited by 20 publications

(21 citation statements)

References 138 publications

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“…A total of 122 published articles formed the evidentiary base for this guideline update. 12 For the included topics, 5 studies provided Class I evidence, 35 provided Class II evidence, and 98 provided Class III evidence. Sixteen manuscripts provided evidence for more than 1 topic.…”

Section: Resultsmentioning

confidence: 99%

“…Ultimately, the 3rd edition panelists chose to recommend maintaining SBP >110 mm Hg while acknowledging that the optimal threshold may be higher. 12 Overall, the literature more strongly supports the avoidance of hypotension than inducing hypertension. Spaite et al 12 and others 24,25 have associated high blood pressures early after TBI with poor outcomes.…”

Section: Blood Pressurementioning

confidence: 99%

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Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary

Hawryluk,

Lulla,

Bell

et al. 2023

Neurosurgery

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Prehospital care markedly influences outcome from traumatic brain injury, yet it remains highly variable. The Brain Trauma Foundation's guidelines informing prehospital care, first published in 2002, have sought to identify and disseminate best practices. Many of its recommendations relate to the management of airway, breathing and circulation, and infrastructure for this care. Compliance with the second edition of these guidelines has been associated with significantly improved survival. A working group developed evidence-based recommendations informing assessment, treatment, and transport decision-making relevant to the prehospital care of brain injured patients. A literature search spanning May 2005 to January 2022 supplemented data contained in the 2nd edition. Identified studies were assessed for quality and used to inform evidence-based recommendations. A total of 122 published articles formed the evidentiary base for this guideline update including 5 providing Class I evidence, 35 providing Class II evidence, and 98 providing Class III evidence for the various topics. Forty evidence-based recommendations were generated, 30 of which were strong and 10 of which were weak. In many cases, new evidence allowed guidelines from the 2nd edition to be strengthened. Development of guidelines on some new topics was possible including the prehospital administration of tranexamic acid. A management algorithm is also presented. These guidelines help to identify best practices for prehospital traumatic brain injury care, and they also identify gaps in knowledge which we hope will be addressed before the next edition.

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Section: Resultsmentioning

confidence: 99%

Section: Blood Pressurementioning

confidence: 99%

Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary

Hawryluk,

Lulla,

Bell

et al. 2023

Neurosurgery

Self Cite

View full text Add to dashboard Cite

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“…The National Athletic Trainers' Association of the United States, in its prehospital trauma life support book emphasizes that knowledge of MOI is extremely useful for identifying specific patterns of injury, especially in TBI, for the assessment and interventions needed. 5 Reviewing the MOI of these two cases indicates the possibility of neck and cervical spine injury in addition to the evidence of head injury from hyperextension. 2 Prehospital trauma life support emphasizes that spinal cord injury should be considered in any blunt trauma mechanism with a severe head impact.…”

Section: For Prehospital Medical Teamsmentioning

confidence: 99%

“…2 Prehospital trauma life support emphasizes that spinal cord injury should be considered in any blunt trauma mechanism with a severe head impact. 5 For TSI, since the head is like a bowling ball placed on top of the neck, its moving mass is usually in a different direction to that of the body, its injury can introduce powerful forces to the cervical spine and spinal cord; the absence of neurological deficit symptoms does not rule out the possibility of unstable cervical spine damage. 1,2 Thus for these two cases, and the Saudi Arabian player in particular, given the clinical symptoms and MOI, the following four steps/principles should have been implemented:…”

Section: For Prehospital Medical Teamsmentioning

confidence: 99%

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Prehospital emergency care for severe and acute head and neck trauma: Lessons learned from the Qatar 2022 World Cup games

Aghababaeian

Yazdi

2023

Trauma

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Guideline Implementation Is Improving Trauma Care in the Wild, Wild West

Jopling,

Kodadek,

Haut

2024

JAMA Surg

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A core tenet in the care of patients with brain injury is prevention of secondary brain injury. In the immediate postinjury period, the patient's physiology must be carefully managed to adequately perfuse and oxygenate the brain.Maintaining optimal oxygenation, ventilation, blood pressure, and temperature is critical to maximize patient outcomes. 1 Even a single instance of deviation from the optimal ranges can lead to additional irreversible brain injury and increase the risk of death. We know the data, but historically have had difficulty changing practice to achieve these targets. How can trauma systems manage patients with brain injury in a way that ensures these physiologic evidence-based goals are met?The trauma care continuum takes place in a series of taskand decision-dense environments. Decisions should be driven by data and we should use a learning health-care system designed to provide evidence-based care. 2 The National Academies of Medicine reminds us that well-implemented practice-management guidelines are key to delivery of evidence-based care at a system level. 2 Practice-management guidelines speed implementation of research into practice, improve quality and safety of care, reduce disparities, lower health care costs, and reduce practice variation. 3 Within this context, the Excellence in Prehospital Injury Care (EPIC) study team implemented an emergency medical services (EMS) guideline across the state of Arizona. Their initial findings demonstrated that guideline implementation was associated with improvement in survival to hospital discharge for patients with severe traumatic brain injury (TBI). 4

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Prehospital Guidelines for the Management of Traumatic Brain Injury – 3rd Edition

Cited by 20 publications

References 138 publications

Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary

Guidelines for Prehospital Management of Traumatic Brain Injury 3rd Edition: Executive Summary

Prehospital emergency care for severe and acute head and neck trauma: Lessons learned from the Qatar 2022 World Cup games

Guideline Implementation Is Improving Trauma Care in the Wild, Wild West

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