Research Reports - Prehospital neurologic deterioration is independent predictor of outcome in traumatic brain injury

Am J Emerg Med. 2013 Aug;31(8):1215-9

Majidi S, Siddiq F, Qureshi AI

BACKGROUND: The prevalence and impact of prehospital neurologic deterioration
(PhND) in patients with traumatic brain injury (TBI) have not been investigated.
We aimed to determine the prevalence of PhND during emergency medical service
(EMS) transportation among patients with TBI and its impact on patient's outcome.
METHODS: We used the National Trauma Data Bank, using data files from 2009 to
2010 to identify patients with TBI through International Classification of
Diseases, Ninth Revision, Clinical Modification diagnosis codes. The initial
Glasgow Coma Scale (GCS) score ascertained at the scene by EMS was compared with
the subsequent GCS score evaluation in the emergency department (ED) to identify
neurologic deterioration (defined as a decrease in GCS of ≥2 points). Patients'
demographics, initial injury severity score (ISS), admission GCS score, and
hospital outcome were compared between patients with PhND and patients without
neurologic deterioration.
RESULTS: A total of 257 127 patients with TBI were identified. Among patients
with TBI, 22 254 patients had PhND, which comprised 9% of all patients with TBI.
The mean of GCS score decrease during EMS transport was 5 points (±3). Patients
without PhND tended to have higher GCS recorded by EMS (median, 15 vs 12; P <
.0001). Patients with TBI who had PhND had significantly higher hospital length
of stay and intensive care unit days after adjusting for baseline characteristics
and EMS GCS score, EMS transport time, type of injury, presence of intracranial
hemorrhages, and ED ISS (P < .0001). These patients had higher rate of
in-hospital mortality after adjusting for the same variables (odds ratio, 2.30;
95% confidence interval, 2.18-2.41).
CONCLUSION: Prehospital neurologic deterioration occurs in 9% of patients with
TBI. It is more prevalent in men and associated with lower EMS GCS level and
higher ED ISS. Prehospital neurologic deterioration is an independent predictor
of worse hospital outcome and higher resource use in patients with TBI.

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