Volume 23 Supplement 2

London Trauma Conference 2014

Open Access

Severe traumatic brain injury- physician provided pre-hospital care and early neurosurgical treatment are associated with improved survival

  • Toni Pakkanen1, 2Email author,
  • Ilkka Virkkunen2,
  • Antti Kämäräinen2,
  • Tom Silfvast3,
  • Tarja Randell3,
  • Heini Huhtala4 and
  • Arvi Yli-Hankala1, 5
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201523(Suppl 2):O9

https://doi.org/10.1186/1757-7241-23-S2-O9

Published: 11 September 2015

Background

Worldwide, traumatic brain injury (TBI) is a leading cause of death and permanent disability[1]. Early and appropriate management of TBI is critical to the survival of these patients [1]. The aim of this study was to compare the outcome of TBI patients in two emergency medical service (EMS) systems.

Method

A 6-year period observational data on pre-hospital TBI management in physician versus paramedic staffed EMS systems were retrospectively analysed. Inclusion criteria were isolated TBI with Glasgow coma scale (GCS) ≤ 8 on-scene or during transportation. Patients with life-threatening multiple trauma, secondary transfers and patients deceased on-scene were excluded. Evaluation was based on patient records one year after the incident. For assessment of neurological outcome, modified Glasgow Outcome Score (GOS) was used. The time and cause of death were recorded.

Results

The physician (n = 275) and paramedic (n = 183) EMS patient groups were similar regarding demographic variables, mechanism of injury, time to reach the patient and first recorded on-scene GCS. Airway was secured in physician EMS group in 98 % and paramedic EMS group in 16 % of the patients (p < 0.001). Emergency neurosurgery was performed on 45 % and 30 % of the patients after hospital admission (p < 0.001). A statistically non-significant trend towards better neurological outcome was observed favouring physician provided pre-hospital care - 38 % of the physician and 31 % of the paramedic treated EMS patients had a good neurological recovery (GOS 4-5) with independent life one year after the event. Correspondingly, the overall one-year mortality rate was lower in the physician staffed EMS group: 43 % vs. 57 % (p < 0.01).

Conclusion

TBI patient mortality was significantly lower and good neurological outcome higher in patients treated by the physician EMS group compared to the paramedic EMS group.

Authors’ Affiliations

(1)
Department of Anaesthesia, Tampere University Hospital
(2)
Tays Emergency Medical Service, Tampere University Hospital
(3)
Department of Anaesthesia and Intensive Care, Helsinki University Hospital, University of Helsinki
(4)
School of Health Sciences, University of Tampere
(5)
Medical School, University of Tampere

References

  1. Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, Jernigan S, Letarte PB, Lerner EB, Moriarty TM, Pons PT, Sasser S, Scalea T, Schleien CL, Wright DW, Brain Trauma Foundation, BTF Center for Guidelines Management: Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehosp Emerg Care. 2008, 12 (Suppl 1): S1-52.View ArticlePubMedGoogle Scholar

Copyright

© Pakkanen et al. 2015

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 (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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