Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014

Open Access 01-12-2014 | Original research

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

Authors: Sophia Tohme, Cecile Delhumeau, Mathias Zuercher, Guy Haller, Bernhard Walder

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2014

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
1.
Mosconi P, Taricco M, Bergamini M, Bosisio Fazzi L, Colombo C, Patrucco V, Corti M, Giobbe D, Guerreschi M, Magnarella MR, Sallemi G: Family burden after severe brain injury: the Italian experience with families and volunteer associations. Patient. 2011, 4: 55-65. 10.2165/11535550-000000000-00000.CrossRefPubMed
2.
Pielmaier L, Walder B, Rebetez MM, Maercker A: Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury. Brain Inj. 2011, 25: 259-265. 10.3109/02699052.2010.542429.CrossRefPubMed
3.
Dikman SS, Ross BL, Machamer JE, Temkin NR: One year psychosocial outcome in head injury. J Int Neuropsy Soc. 1995, 1: 67-77. 10.1017/S1355617700000126.CrossRef
4.
Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE: Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study. Lancet. 2005, 366: 1538-1544. 10.1016/S0140-6736(05)67626-X.CrossRefPubMed
5.
von Elm E, Osterwalder JJ, Graber C, Schoettker P, Stocker R, Zangger P, Vuadens P, Egger M, Walder B: Severe traumatic brain injury in Switzerland - feasibility and first results of a cohort study. Swiss Med Wkly. 2008, 138: 327-334.PubMed
6.
Kool B, Raj N, Wainiqolo I, Kafoa B, McCaig E, Ameratunga S: Hospitalised and fatal head injuries in Viti Levu, Fiji: findings from an island-wide trauma registry (TRIP 4). Neuroepidemiol. 2012, 38: 179-185. 10.1159/000337261.CrossRef
7.
Schirmer-Mikalsen K, Vik A, Gisvold SE, Skandsen T, Hynne H, Klepstad P: Severe head injury: control of physiological variables, organ failure and complications in the intensive care unit. Acta Anaesthesiol Scand. 2007, 51: 1194-1201.PubMed
8.
Baguley IJ, Nott MT, Howle AA, Simpson GK, Browne S, King AC, Cotter RE, Hodgkinson A: Late mortality after severe traumatic brain injury in New South Wales: a multicentre study. Med J Aust. 2012, 196: 40-45.CrossRefPubMed
9.
Rosenfeld JV, Maas AI, Bragge P, Morganti-Kossmann MC, Manley GT, Gruen RL: Early management of severe traumatic brain injury. Lancet. 2012, 380: 1088-1098. 10.1016/S0140-6736(12)60864-2.CrossRefPubMed
10.
Sheps Mangulies S, Thibault LE, Gennarelli TA: Physical model simulations of brain injury in the primate. J Biomechanics. 1990, 23: 823-836. 10.1016/0021-9290(90)90029-3.CrossRef
11.
Kalia LV, Kalia SK, Salter MW: NMDA receptors in clinical neurology: excitatory times ahead. Lancet Neurol. 2008, 7: 742-755. 10.1016/S1474-4422(08)70165-0.PubMedCentralCrossRefPubMed
12.
Morganti-Kossmann MC, Satgunaseelan L, Bye N, Kossmann T: Modulation of immune response by head injury. Injury. 2007, 38: 1392-1400. 10.1016/j.injury.2007.10.005.CrossRefPubMed
13.
Cernak I, Vink R, Zapple DN, Cruz MI, Ahmed F, Chang T, Fricke ST, Faden AI: The pathobiology of moderate diffuse traumatic brain injury as identified using a new experimental model of injury in rats. Neurobiol Dis. 2004, 17: 29-43. 10.1016/j.nbd.2004.05.011.CrossRefPubMed
14.
Hellal F, Bonnefont-Rousselot D, Crocci N, Palmier B, Plotkine M, Marchand-Verrecchia C: Pattern of cerebral edema and hemorrhage in a mice model of diffuse brain injury. Neurosci Lett. 2004, 357: 21-24. 10.1016/j.neulet.2003.12.036.CrossRefPubMed
15.
McHugh GS, Engel DC, Butcher I, Steyerberg EW, Lu J, Mushkudiani N, Hernandez AV, Marmarou A, Maas AI, Murray GD: Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007, 24: 287-293. 10.1089/neu.2006.0031.CrossRefPubMed
16.
Hukkelhoven CW, Steyerberg EW, Farace E, Habbema JD, Marshall LF, Maas AI: Regional differences in patient characteristics, case management, and outcomes in traumatic brain injury: experience from the tirilazad trials. J Neurosurg. 2002, 97: 549-557. 10.3171/jns.2002.97.3.0549.CrossRefPubMed
17.
Franschman G, Peerdeman SM, Andriessen TM, Greuters S, Toor AE, Vos PE, Bakker FC, Loer SA, Boer C: Effect of secondary prehospital risk factors on outcome in severe traumatic brain injury in the context of fast access to trauma care. J Trauma. 2011, 71: 826-832. 10.1097/TA.0b013e31820cebf0.CrossRefPubMed
18.
de Ribaupierre S: Trauma and impaired consciousness. Neurol Clin. 2011, 29: 883-902. 10.1016/j.ncl.2011.07.012.CrossRefPubMed
19.
Brenner M, Stein D, Hu P, Kufera J, Wooford M, Scalea T: Association between early hyperoxia and worse outcomes after traumatic brain injury. Arch Surg. 2012, 147: 1042-1046. 10.1001/archsurg.2012.1560.CrossRefPubMed
20.
Hamill RW, Woolf PD, McDonald JV, Lee LA, Kelly M: Catecholamines predict outcome in traumatic brain injury. Ann Neurol. 1987, 21: 438-443. 10.1002/ana.410210504.CrossRefPubMed
21.
Woolf PD, Hamill RW, Lee LA, Cox C, McDonald JV: The predictive value of catecholamines in assessing outcome in traumatic brain injury. J Neurosurg. 1987, 66: 875-882. 10.3171/jns.1987.66.6.0875.CrossRefPubMed
22.
Leon-Carrion J, Leon-Dominguez U, Pollonini L, Wu MH, Frye RE, Dominguez-Morales MR, Zouridakis G: Synchronization between the anterior and posterior cortex determines consciousness level in patients with traumatic brain injury (TBI). Brain Res. 2012, 1476: 22-30.CrossRefPubMed
23.
Kouloulas EJ, Papadeas AG, Michail X, Sakas DE, Boviatsis EJ: Prognostic value of time-related Glasgow Coma Scale components in severe traumatic brain injury: a prospective evaluation with respect to 1-year survival and functional outcome. Int J Rehabil Res. 2013, 36: 260-267. 10.1097/MRR.0b013e32835fd99a.CrossRefPubMed
24.
Walder B, Haller G, Rebetez MM, Delhumeau C, Bottequin E, Schoettker P, Ravussin P, Brodmann Maeder M, Stover JF, Zürcher M, Haller A, Wäckerlin A, Haberthür C, Fandino J, Haller CS, Osterwalder J: Severe traumatic brain injury in a high-income country: An epidemiological study. J Neurotrauma. 2013, 30: 1934-1942. 10.1089/neu.2013.2955.CrossRefPubMed
25.
Garthe E, States JD, Mango NK: Abbreviated injury scale unification: the case for a unified injury system for global use. J Trauma. 1999, 47: 309-323. 10.1097/00005373-199908000-00016.CrossRefPubMed
26.
Patel NY, Hoyt DB, Nakaji P, Marshall L, Holbrook T, Coimbra R, Winchell RJ, Mikulaschek AW: Traumatic brain injury: patterns of failure of nonoperative management. J Trauma. 2000, 48: 367-374. 10.1097/00005373-200003000-00001.CrossRefPubMed
27.
Zuercher M, Ummenhofer W, Baltussen A, Walder B: The use of Glasgow Coma Scale in injury assessment: a critical review. Brain Inj. 2009, 23: 371-384. 10.1080/02699050902926267.CrossRefPubMed
28.
Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW: The Injury Severity Score revisited. J Trauma. 1988, 28: 69-77. 10.1097/00005373-198801000-00010.CrossRefPubMed
29.
Schreiber MA, Aoki N, Scott BG, Beck JR: Determinants of mortality in patients with severe blunt head injury. Arch Surg. 2002, 137: 285-290. 10.1001/archsurg.137.3.285.CrossRefPubMed
30.
Bukur M, Kurtovic S, Berry C, Tanios M, Ley EJ, Salim A: Pre-hospital hypothermia is not associated with increased survival after traumatic brain injury. J Surg Res. 2011, 175: 24-29.CrossRefPubMed
31.
Hartl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J: Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma. 2006, 60: 1250-1256. 10.1097/01.ta.0000203717.57821.8d.CrossRefPubMed
32.
Berry C, Ley EJ, Bukur M, Malinoski D, Margulies DR, Mirocha J, Salim A: Redefining hypotension in traumatic brain injury. Injury. 2011, 43: 1833-1837.CrossRefPubMed
33.
Butcher I, Maas AI, Lu J, Marmarou A, Murray GD, Mushkudiani NA, McHugh GS, Steyerberg EW: Prognostic value of admission blood pressure in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007, 24: 294-302. 10.1089/neu.2006.0032.CrossRefPubMed
34.
Haut ER, Kalish BT, Cotton BA, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE, Chang DC: Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Ann Surg. 2011, 253: 371-377. 10.1097/SLA.0b013e318207c24f.CrossRefPubMed
35.
Cooper DJ, Myles PS, McDermott FT, Murray LJ, Laidlaw J, Cooper G, Tremayne AB, Bernard SS, Ponsford J: Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004, 291: 1350-1357. 10.1001/jama.291.11.1350.CrossRefPubMed
36.
Lundgren P, Henriksson O, Naredi P, Bjornstig U: The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial. Scand J Trauma Resusc Emerg Med. 2011, 19: 59-10.1186/1757-7241-19-59.PubMedCentralCrossRefPubMed
37.
Lockey DJ, Coats T, Parr MJ: Aspiration in severe trauma: a prospective study. Anaesthesia. 1999, 54: 1097-1098. 10.1046/j.1365-2044.1999.00754.x.CrossRefPubMed
38.
Vadeboncoeur TF, Davis DP, Ochs M, Poste JC, Hoyt DB, Vilke GM: The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation. J Emerg Med. 2006, 30: 131-136. 10.1016/j.jemermed.2005.04.019.CrossRefPubMed
39.
von Elm E, Schoettker P, Henzi I, Osterwalder J, Walder B: Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence. Br J Anaesth. 2009, 103: 371-386. 10.1093/bja/aep202.CrossRefPubMed
Metadata
Title
Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study
Authors
Sophia Tohme
Cecile Delhumeau
Mathias Zuercher
Guy Haller
Bernhard Walder
Publication date
01-12-2014
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-22-1

Other articles of this Issue 1/2014

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014 Go to the issue

Original research

Red blood cell transfusion in septic shock - clinical characteristics and outcome of unselected patients in a prospective, multicentre cohort

Original research

Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial

Original research

Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages

Original research

Increased risk of ischemic stroke in patients with mild traumatic brain injury: a nationwide cohort study

Original research

The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries

Commentary

Quality improvement in pre-hospital critical care: increased value through research and publication