A1 Refereed original research article in a scientific journal
Prehospital Management of Traumatic Brain Injury across Europe: A CENTER-TBI Study
Authors: Gravesteijn BY, Sewalt CA, Stocchetti N, Citerio G, Ercole A, Lingsma HF, von Steinbuchel N, Steyerberg EW, Wilson L, Maas AIR, Menon DK, Lecky FE; CENTER-TBI collaborators
Publisher: TAYLOR & FRANCIS INC
Publication year: 2020
Journal: Prehospital Emergency Care
Journal name in source: PREHOSPITAL EMERGENCY CARE
Journal acronym: PREHOSP EMERG CARE
Number of pages: 15
ISSN: 1090-3127
eISSN: 1545-0066
DOI: https://doi.org/10.1080/10903127.2020.1817210
Web address : https://www.tandfonline.com/doi/full/10.1080/10903127.2020.1817210
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/52207576
Background Prehospital care for traumatic brain injury (TBI) is important to prevent secondary brain injury. We aim to compare prehospital care systems within Europe and investigate the association of system characteristics with the stability of patients at hospital arrival.
Methods We studied TBI patients who were transported to CENTER-TBI centers, a pan-European, prospective TBI cohort study, by emergency medical services between 2014 and 2017. The association of demographic factors, injury severity, situational factors, and interventions associated with on-scene time was assessed using linear regression. We used mixed effects models to investigate the case mix adjusted variation between countries in prehospital times and interventions. The case mix adjusted impact of on-scene time and interventions on hypoxia (oxygen saturation <90%) and hypotension (systolic blood pressure <100mmHg) at hospital arrival was analyzed with logistic regression.
Results Among 3878 patients, the greatest driver of longer on-scene time was intubation (+8.3 min, 95% CI: 5.6-11.1). Secondary referral was associated with shorter on-scene time (-5.0 min 95% CI: -6.2- -3.8). Between countries, there was a large variation in response (range: 12-25 min), on-scene (range: 16-36 min) and travel time (range: 15-32 min) and in prehospital interventions. These variations were not explained by patient factors such as conscious level or severity of injury (expected OR between countries: 1.8 for intubation, 1.8 for IV fluids, 2.0 for helicopter). On-scene time was not associated with the regional EMS policy (p= 0.58). Hypotension and/or hypoxia were seen in 180 (6%) and 97 (3%) patients in the overall cohort and in 13% and 7% of patients with severe TBI (GCS <8). The largest association with secondary insults at hospital arrival was with major extracranial injury: the OR was 3.6 (95% CI: 2.6-5.0) for hypotension and 4.4 (95% CI: 2.9-6.7) for hypoxia.
Discussion Hypoxia and hypotension continue to occur in patients who suffer a TBI, and remain relatively common in severe TBI. Substantial variation in prehospital care exists for patients after TBI in Europe, which is only partially explained by patient factors.
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