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Prehospital care in patients with severe traumatic brain injury: does the level of prehospital care influence mortality?

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Abstract

Introduction and purpose

The controversy between the “scoop and run” versus the “stay and play” approach in severely injured trauma patients has been an ongoing issue for decades. The present study was undertaken to investigate whether changes in prehospital care for patients with severe traumatic brain injury in the Netherlands have improved outcome.

Methods

In this retrospective study, files (n = 60) were analyzed from a prospectively collected database including all patients admitted to one of six hospitals in the Limburg region in the Netherlands with a Glasgow Coma Scale (GCS) score ≤8 on admittance over the period from January 2006 to December 2008. All patients had traumatic brain damage proven on computed tomography (CT) or magnetic resonance imaging (MRI). Relevant prehospital and clinical data from the present cohort were compared to data from a similar study (n = 30) conducted 20 years ago. The primary outcome assessed was mortality.

Results

The two study groups had similar characteristics with regard to the GCS score. In the historic cohort, Basic Life Support (BLS) and the “scoop and run” approach in patients with major traumatic brain injury was common, with an average time on scene of 7.5 min. Currently, prehospital care is performed mainly on the level of prehospital Advanced Life Support (ALS), with the average time on scene being about four times as long as in the historic cohort. However, the overall mortality rate for the current cohort compared to the historic cohort has not changed.

Conclusion

Despite more on-site ALS in severely head injured patients nowadays compared to the historic cohort, there was no reduction in mortality.

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Conflict of interest

The authors did not receive any outside funding or grants in support of their research for the preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed or agreed to pay or direct any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors or a member of their immediate families are affiliated or associated.

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Authors and Affiliations

  1. Network Acute Care Limburg, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    M. M. F. Aubuchon, B. Hemmes & P. R. G. Brink

  2. Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    M. Poeze & P. R. G. Brink

  3. Department of Anaesthesiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    J. Jansen

  4. Bogaartsborg 3, 6228 AK, Maastricht, The Netherlands

    B. Hemmes

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  1. M. M. F. Aubuchon
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Correspondence to B. Hemmes.

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Aubuchon, M.M.F., Hemmes, B., Poeze, M. et al. Prehospital care in patients with severe traumatic brain injury: does the level of prehospital care influence mortality?. Eur J Trauma Emerg Surg 39, 35–41 (2013). https://doi.org/10.1007/s00068-012-0218-6

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