The prehospital management of traumatic brain injury

Goldberg, Scott A; Rojanasarntikul, Dhanadol; Jagoda, Andrew

doi:10.1016/b978-0-444-52892-6.00023-4

Cited by 18 publications

(6 citation statements)

References 116 publications

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“…In the interaction analysis, patients with high oxygen saturation after high-flow oxygen showed significantly poor outcomes (AOR 1.33 (95%CI: 1.01-1.74)), which implies that hyperoxia could be harmful. Some authors reported that prehospital advanced airway techniques were related to poor outcomes in traumatic brain injury and that this was associated with prehospital hyperventilation, which was very common (60~70%); even the prehospital guideline recommends not to hyperventilate [27][28][29][30]. In this study setting, prehospital advanced airway techniques, including laryngeal mask airway and endotracheal intubation, were uncommon (1.4%) because cases with prehospital hypoxia less than 94% were excluded.…”

Section: Discussionmentioning

confidence: 81%

Association of Flow Rate of Prehospital Oxygen Administration and Clinical Outcomes in Severe Traumatic Brain Injury

Hong

Shin

et al. 2021

JCM

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The goal of this study was to investigate the association of prehospital oxygen administration flow with clinical outcome in severe traumatic brain injury (TBI) patients. This was a cross-sectional observational study using an emergency medical services-assessed severe trauma database in South Korea. The sample included adult patients with severe blunt TBI without hypoxia who were treated by EMS providers in 2013 and 2015. Main exposure was prehospital oxygen administration flow rate (no oxygen, low-flow 1~5, mid-flow 6~14, high-flow 15 L/min). Primary outcome was in-hospital mortality. A total of 1842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen, mid-flow oxygen, high-flow oxygen was 244, 573, 607, and 418, respectively. Mortality of each group was 34.8%, 32.3%, 39.9%, and 41.1%, respectively. Compared with the no-oxygen group, adjusted odds (95% CI) for mortality in the low-, mid-, and high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60), and 1.21 (0.83–1.73), respectively. In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94–98% (adjusted odds ratio (AOR): 0.80 (0.67–0.95)) and ≥99% (AOR: 0.69 (0.53–0.91)). High-flow oxygen showed higher mortality when prehospital oxygen saturation was ≥99% (AOR: 1.33 (1.01~1.74)). Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group. High-flow administration showed higher mortality.

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Section: Discussionmentioning

confidence: 81%

Association of Flow Rate of Prehospital Oxygen Administration and Clinical Outcomes in Severe Traumatic Brain Injury

Hong

Shin

et al. 2021

JCM

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“…Some authors reported prehospital advance airway was related to poor outcomes in traumatic brain injury, and this was associated with prehospital hyperventilation, which was very common (60 ~ 70%); even the prehospital guideline recommends not to hyperventilate. [27][28][29][30] In this study settings, prehospital advanced airway, including laryngeal mask airway and endotracheal intubation, was uncommon (1.4%) because cases with prehospital hypoxia less than 94% were excluded. When we analysed that separately, it did not in uence our result.…”

Section: Discussionmentioning

confidence: 99%

Association of flow rate of prehospital oxygen administration and clinical outcomes in severe traumatic brain injury

Hong

Shin

et al. 2021

Preprint

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Background To prevent hypoxia during prehospital phase is important in severe traumatic brain injury (TBI) but optimal flow rate of prehospital oxygen supply is controversial. The goal of this study is to investigate the association of prehospital oxygen administration flow on clinical outcome in severe TBI patients. Methods This is a cross-sectional observational study using emergency medical services assessed severe trauma database in South Korea. In 2013 and 2015, adult patients with severe blunt TBI (abbreviated injury scale ≥3 in head lesion) without hypoxia (< 94% of oxygen saturation in prehospital pulse oximetry) were included. Main exposure was prehospital oxygen administration flow rate (no oxygen, 1~5 L/min, 6~14 L/min, 15 L/min). Primary outcome was in-hospital mortality. A multivariate logistic regression model was used to association of prehospital oxygen supply and outcomes. Results 1,842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen (1~5 L/min), mid-flow oxygen (6~14 L/min), high-flow oxygen (15 L/min) was 244, 573, 607 and 418. Mortality of each group was 34.8%, 32.3%, 39.9% and 41.1%. Compared with no-oxygen group, adjusted odds (95% CI) for mortality in the low, mid, high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60) and 1.21 (0.83–1.73). In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94-98% (adjusted odds ratio(AOR): 0.80 [0.67–0.95]) and ≥99% (AOR: 0.69 [0.53–0.91]). High-flow oxygen (15 L/min) showed higher mortality when prehospital saturation was ≥99% in pulse oximetry (AOR: 1.33[1.01~1.74]). Conclusions Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group in severe TBI patients. High-flow oxygen administration showed higher mortality. Optimal flow of prehospital oxygenation according prehospital saturation could reduce mortality in severe TBI. Trial registration This study used cases retrospectively registered in the emergency medical services assessed severe trauma database.

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“…In the literature, the error rate resulting from evaluation with GCS is stated as 40% [ 15 ]. It is not correct to use the scoring systems in patients with impaired motor responses or who have an attention deficit, a lack of arousal, or a lack of perception [ 16 , 17 ]. The GCS is designed for serial assessments, so it should be emphasized that any confidence in predicting outcomes cannot be sufficiently established until a trend is achieved in the GCS [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Electroencephalography Analysis for Improved Assessment of Consciousness Levels in Deep Coma Patients Using a Proposed Stimulus Stage

et al. 2023

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“Coma” is defined as an inability to obey commands, to speak, or to open the eyes. So, a coma is a state of unarousable unconsciousness. In a clinical setting, the ability to respond to a command is often used to infer consciousness. Evaluation of the patient’s level of consciousness (LeOC) is important for neurological evaluation. The Glasgow Coma Scale (GCS) is the most widely used and popular scoring system for neurological evaluation and is used to assess a patient’s level of consciousness. The aim of this study is the evaluation of GCSs with an objective approach based on numerical results. So, EEG signals were recorded from 39 patients in a coma state with a new procedure proposed by us in a deep coma state (GCS: between 3 and 8). The EEG signals were divided into four sub-bands as alpha, beta, delta, and theta, and their power spectral density was calculated. As a result of power spectral analysis, 10 different features were extracted from EEG signals in the time and frequency domains. The features were statistically analyzed to differentiate the different LeOC and to relate with the GCS. Additionally, some machine learning algorithms have been used to measure the performance of the features for distinguishing patients with different GCSs in a deep coma. This study demonstrated that GCS 3 and GCS 8 patients were classified from other levels of consciousness in terms of decreased theta activity. To the best of our knowledge, this is the first study to classify patients in a deep coma (GCS between 3 and 8) with 96.44% classification performance.

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The prehospital management of traumatic brain injury

Cited by 18 publications

References 116 publications

Association of Flow Rate of Prehospital Oxygen Administration and Clinical Outcomes in Severe Traumatic Brain Injury

Association of Flow Rate of Prehospital Oxygen Administration and Clinical Outcomes in Severe Traumatic Brain Injury

Association of flow rate of prehospital oxygen administration and clinical outcomes in severe traumatic brain injury

Quantitative Electroencephalography Analysis for Improved Assessment of Consciousness Levels in Deep Coma Patients Using a Proposed Stimulus Stage

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