Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

Abstract

BackgroundSevere traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days.MethodsA multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ≤13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models.Results589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor.ConclusionMortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired consciousness.

Pre-hospital management of mass casualty civilian shootings: a systematic literature review

“…This systematic literature review identified the need for integration of tactical emergency medical services [11], improved cross-service education on effective haemorrhage control [27], the need for early effective triage by senior clinicians and the need for regular mass casualty incident simulation [5, 23]. …”

“…Uniform and comprehensive reporting of mass casualty shootings is required, along with a dedicated recording database for the occurrence of these incidents outside the USA [5]. Epidemiology in this global phenomenon is incomplete; clinical experience from shootings in many countries has not been published, including high profile events like the Sousse attacks in Tunisia 2015.…”

“…Major incident is defined in a consensus paper on reporting pre-hospital major incident medical management as “an incident that requires the mobilization of extraordinary Emergency Medical Services (EMS) resources and is identified as a major incident in that system” [5]. Inclusion of only civilian major incidents allows comparison of civilian pre-hospital medical services and avoids confusion with very differently prepared and resourced military medical services.…”

Higher haemoglobin levels and dedicated trauma admission are associated with survival after severe traumatic brain injury

“…Tohme et al [19] found that pre-hospital hypotension and hypothermia were independently associated with mortality among patients with TBI and that pre-hospital hypoxemia was associated with impaired consciousness at 14 days post-TBI. Chhabra et al [20] found that, among patients with TBI, the presence of coagulopathy on hospital days 1 or 3 strongly predicted in-hospital mortality.…”

Association between the Osteoporosis Self-Assessment Tool for Asians Score and Mortality in Patients with Isolated Moderate and Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis

“…In this study, age, gender, co-morbidity, BAC, GCS, and ISS were used as covariates for the propensity score-matching. In addition to being comorbidities, GCS and ISS have been well recognized as independent risk factors for mortality due to TBI [24,25,26,27]; gender and BAC also may have a significant effect on the mortality of patients who sustained TBI [28,29]. In a retrospective study of 1627 TBI patients, female patients had a significantly higher mortality (3.4% vs. 1.6%, p = 0.048) [30].…”