Research Reports - Do prolonged transport times for traumatic brain injury patients result in deteriorating physiology?

Prehosp Emerg Care. 2013 Oct 10

Fuller G, Woodford M, Lawrence T, Coats T, Lecky F

Abstract Background. Recent interest has focused on reorganizing emergency
medical services (EMS) for traumatic brain injury (TBI) patients, with bypass of
nonspecialist hospitals and direct transportation to distant neuroscience
centers. Although this could expedite neurosurgery and neurocritical care,
deteriorating physiology could be deleterious. Methods. We performed a
multicenter cohort study examining adult patients with significant TBI enrolled
in the English National Trauma Registry. The distributions and correlation of
first recorded prehospital and emergency department (ED) vital signs were
compared, and the effect of time on changes in vital signs was examined in
bivariate and multivariate analyses. Results. A total of 7149 eligible patients
were studied. No clinically significant differences were apparent between
distributions of prehospital and ED vital signs. Moderate linear correlation was
observed for field and ED pulse rate (r(2) = 0.34) and GCS values (Spearman's rho
= 0.76), with weak correlation apparent for systolic blood pressure (r(2) = 0.28)
and respiratory rate (r(2) = 0.28). Eight percent of cases' vital signs
deteriorated in the prehospital interval; however, odds of deterioration in vital
sign status did not vary significantly with duration of EMS interval. Conclusion.
The similarity between prehospital and ED vital signs, and lack of association
between EMS interval and physiological deterioration, may support a strategy of
direct transportation of TBI cases to specialist centers. Further research is
necessary to identify patients at risk from deterioration during bypass and to
investigate effects on mortality.

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