Research Reports - Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury
Scand J Trauma Resusc Emerg Med. 2014 Jan 7;22(1):1
Tohme S, Delhumeau C, Zuercher M, Haller G, Walder B
BACKGROUND: Severe 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.
METHODS: A 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.
RESULTS: 589 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.
CONCLUSION: Mortality 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.