EBQ:Prehospital Hypoxia in Brain Trauma

Under Review Journal Club Article

Chi JH. "Prehospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicenter study". J. Trauma. 2006. 61(5):1134-41.
PubMed PDF

Clinical Question

The goals of this study were to determine the incidence and duration of hypotension and hypoxia in the prehospital setting in patients with potentially survivable brain injuries, and to prospectively examine the association of these secondary insults with mortality and disability at hospital discharge.

Conclusion

Secondary insults after TBI are common, and these insults are associated with disability. Hypoxia in the prehospital setting significantly increases the odds of mortality after brain injury controlled for multiple variables.

Design

Prospective cohort study

Population

Trauma patients undergoing helicopter transport to 4 Level I trauma centers during a 2 year period identified by flight nurses or paramedics as having a suspected head injury.

Inclusion Criteria

Inclusion criteria were

1. Diagnosis of acute traumatic brain injury confirmed by CT, operative findings, or autopsy findings
2. Head Abbreviated Injury Scale (AIS) score of �3 or Glasgow Coma Scale (GCS) score of �12 within the first 24 hours of admission (not influenced by alcohol intoxication, sedatives, or muscle relaxants).

Exclusion Criteria

1. no abnormal intracranial findings on the patient’s CT scan
2. determination of a nonsurvivable injury (based on an AIS score of 6 for any body region)
3. death in less than 12 hours after injury