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.
journal_name
Scand J Trauma Resusc Emerg Medauthors
Pakkanen T,Nurmi J,Huhtala H,Silfvast Tdoi
10.1186/s13049-019-0590-xsubject
Has Abstractpub_date
2019-01-28 00:00:00pages
9issue
1issn
1757-7241pii
10.1186/s13049-019-0590-xjournal_volume
27pub_type
杂志文章abstract::Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related s...
journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 社论
doi:10.1186/1757-7241-21-4
更新日期:2013-01-23 00:00:00
abstract:BACKGROUND:Telephone triage entails assessment of urgency and direction of flow in out-of-hours (OOH) services, while visual cues are inherently lacking. Triage tools are recommended but current tools fail to provide systematic assessment of the caller's perspective. Research demonstrated that callers can scale their d...
journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
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更新日期:2019-04-11 00:00:00
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 社论
doi:10.1186/1757-7241-18-15
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章,多中心研究
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章,随机对照试验
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pub_type: 共识发展会议,杂志文章,实务指引
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pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章
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更新日期:2018-02-09 00:00:00
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章
doi:10.1186/s13049-019-0688-1
更新日期:2019-12-10 00:00:00
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章
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更新日期:2010-08-31 00:00:00
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journal_title:Scandinavian journal of trauma, resuscitation and emergency medicine
pub_type: 杂志文章,多中心研究
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更新日期:2014-01-08 00:00:00
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pub_type: 杂志文章
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更新日期:2018-11-22 00:00:00