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Citation
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Haltmeier T, Schnüriger B, Benjamin E, Maeder MB, Künzler M, Siboni S, Inaba K, Demetriades D. J. Trauma Acute Care Surg. 2015; 80(2): 296-301. |
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Affiliation
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1Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA 2University Clinic for Visceral Surgery and Medicine, 3Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern, Switzerland. |
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Abstract
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BACKGROUND: The ideal prehospital management of patients with severe traumatic brain injury (TBI) including the impact of endotracheal intubation (ETI) and physicians on scene is unclear. Prehospital management differs substantially in Switzerland and the USA: in Switzerland there is usually a physician on scene who may provide ETI and other advanced life support procedures, whereas in the USA prehospital management (including ETI) is performed by paramedics.
METHODS: Retrospective cohort-matched study of patients with isolated blunt severe TBI (head AIS 4-5) and no major extracranial injuries, utilizing Bern University Hospital data from the Swiss PEBITA (TBI-specific) database and the US National Trauma Data Bank (NTDB) 2009-2010. A 1:4 cohort matching of Bern and US patients was performed. Matching criteria were sex, age (+/-10 years), exact field GCS, exact head AIS, and injury type (subdural hematoma, epidural hematoma, intraparenchymal hemorrhage, intraventricular hemorrhage, brain edema/swelling, brain stem injury). The matched cohorts were compared with univariable analysis (Fisher's exact and Mann-Whitney U test).
RESULTS: Matching of the Bern (n=128) and US cohort (n=86'375) resulted in 355 matched cases (71 Bern and 284 US). Bern patients had significantly longer scene times (median 23.0 vs. 9.0 min., p<0.001), and more frequent prehospital ETI (31.0 vs 18.7%, p=0.034) and air transportation (39.4 vs 19.4%, p<0.001). No significant difference in procedures (craniotomy/craniectomy, ICP-monitoring, tracheotomy), Intensive Care Unit (ICU) and total hospital length of stay (LOS), ventilator days, and in-hospital mortality (14.1 vs 15.8%, p=0.855) was found between the two cohorts.
CONCLUSION: Taking into account the limitation that patient- and injury-related factors, but not in-hospital treatment variables were matched, the more frequent prehospital ETI and presence of a physician on scene in the Swiss cohort compared to the US cohort had no significant effect on outcomes, including ICU and total hospital LOS, ventilator days, and in-hospital mortality. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Language: en |