Prehospital on-scene anaesthetist treating severe traumatic brain injury patients is associated with lower mortality and better neurological outcome

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dc.contributor.author Pakkanen, Toni
dc.contributor.author Nurmi, Jouni
dc.contributor.author Huhtala, Heini
dc.contributor.author Silfvast, Tom
dc.date.accessioned 2019-02-03T04:18:54Z
dc.date.available 2019-02-03T04:18:54Z
dc.date.issued 2019-01-28
dc.identifier.citation Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2019 Jan 28;27(1):9
dc.identifier.uri http://hdl.handle.net/10138/298629
dc.description.abstract Abstract Background Patients with isolated traumatic brain injury (TBI) are likely to benefit from effective prehospital care to prevent secondary brain injury. Only a few studies have focused on the impact of advanced interventions in TBI patients by prehospital physicians. The primary end-point of this study was to assess the possible effect of an on-scene anaesthetist on mortality of TBI patients. A secondary end-point was the neurological outcome of these patients. Methods Patients with severe TBI (defined as a head injury resulting in a Glasgow Coma Score of ≤8) from 2005 to 2010 and 2012–2015 in two study locations were determined. Isolated TBI patients transported directly from the accident scene to the university hospital were included. A modified six-month Glasgow Outcome Score (GOS) was defined as death, unfavourable outcome (GOS 2–3) and favourable outcome (GOS 4–5) and used to assess the neurological outcomes. Binary logistic regression analysis was used to predict mortality and good neurological outcome. The following prognostic variables for TBI were available in the prehospital setting: age, on-scene GCS, hypoxia and hypotension. As per the hypothesis that treatment provided by an on-scene anaesthetist would be beneficial to TBI outcomes, physician was added as a potential predictive factor with regard to the prognosis. Results The mortality data for 651 patients and neurological outcome data for 634 patients were available for primary and secondary analysis. In the primary analysis higher age (OR 1.06 CI 1.05–1.07), lower on-scene GCS (OR 0.85 CI 0.79–0.92) and the unavailability of an on-scene anaesthetist (OR 1.89 CI 1.20–2.94) were associated with higher mortality together with hypotension (OR 3.92 CI 1.08–14.23). In the secondary analysis lower age (OR 0.95 CI 0.94–0.96), a higher on-scene GCS (OR 1.21 CI 1.20–1.30) and the presence of an on-scene anaesthetist (OR 1.75 CI 1.09–2.80) were demonstrated to be associated with good patient outcomes while hypotension (OR 0.19 CI 0.04–0.82) was associated with poor outcome. Conclusion Prehospital on-scene anaesthetist treating severe TBI patients is associated with lower mortality and better neurological outcome.
dc.publisher BioMed Central
dc.subject Prehospital emergency care (MeSH)
dc.subject Emergency medical services (MeSH)
dc.subject Critical care (MeSH)
dc.subject Traumatic brain injury (MeSH)
dc.subject Airway management (MeSH)
dc.subject Endotracheal intubation (MeSH)
dc.subject Patient outcome assessment (MeSH)
dc.subject Glasgow outcome scale (MeSH)
dc.title Prehospital on-scene anaesthetist treating severe traumatic brain injury patients is associated with lower mortality and better neurological outcome
dc.date.updated 2019-02-03T04:18:54Z
dc.language.rfc3066 en
dc.rights.holder The Author(s).
dc.type.uri http://purl.org/eprint/entityType/ScholarlyWork
dc.type.uri http://purl.org/eprint/entityType/Expression
dc.type.uri http://purl.org/eprint/type/JournalArticle

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