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Volume 22 Supplement 1

London Trauma Conference 2013

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Pre-hospital management of severe traumatic brain injury- compliance with guidelines


Traumatic brain injury (TBI) is a major cause of death and disability. Guidelines for pre-hospital management of severe TBI have been published but research has shown that pre-hospital management often differs from that recommended in guidelines.


To assess compliance with guidelines in the pre-hospital management of severe TBI in Stockholm, in assessment and/or treatment of airway, ventilation, oxygenation, blood pressure, fluid resuscitation, GCS, and pupil properties.


The study was a cross sectional observational study based on data from trauma registry and ambulance records. Included patients (n=101) were adult (age > 15 years), with Injury Severity Score > 9 and GCS 3-8 (severe TBI caused by blunt trauma), transported by ambulance or helicopter and admitted to the trauma center at Karolinska University Hospital in Stockholm between January 1st and December 31st, 2008. TBI were confirmed by computer tomography and with a corresponding ICD-10 diagnosis (s06.0-06.91). The pre-hospital management considered compliant with guidelines only if the assessment or the treatment was documented in the ambulance journal. A 65% criterion was used as a lower limit for acceptable compliance.


Compliance with guidelines was; oxygenation assessment 90.1%, hypoxia treatment 100.0 %, blood pressure assessment 88.1%, hypotension treatment 90.0%, Glasgow Coma Scale 76.2% and pupil properties assessment 93.1%.


The pre-hospital management of severe TBI was to a large extent compliant with the guidelines in Stockholm and compliance was higher compared with that of previous studies.


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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Rubenson Wahlin, R.M., Gustavsson, J. & Castrén, M.K. Pre-hospital management of severe traumatic brain injury- compliance with guidelines. Scand J Trauma Resusc Emerg Med 22 (Suppl 1), P1 (2014).

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