Effect of pre-hospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury


Petra Klemen
Center for Emergency Medicine Maribor
Ulica Talcev 9
Maribor 2000
e-mail: petraklemen@email.si


Background:  The role of pre-hospital trauma care and the effect of pre-hospital rapid sequence intubation (RSI) on patient outcome are still not clear. This study evaluated the impact of pre-hospital trauma care by emergency physicians (EP) on mortality from severe traumatic brain injury (TBI) and a 180-day Glasgow Outcome Scale (GOS).

Methods:  A 48-month parallel non-controlled cohort study compared a group of 64 patients with severe TBI [Glasgow Coma Scale (GCS) < 9; Injury Severity Score (ISS) > 15] who received pre-hospital advanced life support (ALS) with RSI and were transported to the hospital by EPs (EP group), with a group of 60 patients who did not receive pre-hospital ALS with RSI [emergency medical technicians (EMT) group].

Results:  There were no significant statistical differences between the groups in age (P= 0.79), mechanism of injury (P= 0.68), gender (P= 0.82), initial GCS (P= 0.63), initial SaO2 in the field (P= 0.63), initial systolic blood pressure in the field (P= 0.47) and on-scene time (P= 0.41). In the EP group, there was significantly better first hour survival (97% vs. 79%, P= 0.02), first day survival (90% vs. 72%, P= 0.02), better functional outcome (GOS 4–5: 53% vs. 33%, P < 0.01; GOS 2–3: 8% vs. 20%, P < 0.01) and shortened hospitalization time in intensive care unit (ICU) (P= 0.03) and other departments (P= 0.04). In total hospital mortality, we detected no differences between both groups [EP group: 40% (95% CI: 34–45%) vs. EMT group 42% (95% CI: 36–47%, P= 0.76], except in a subgroup of patients with GCS 6–8 where there was significantly lower total hospital mortality in the EP group (24% vs. 78%, P < 0.01).

Conclusion:  After starting the trauma care system with emergency physicians in our region, there was a decrease in the number of deaths on hospital admission, a reduction in hospital mortality in the GCS group 6–8, a change in the temporal distribution of deaths, an improvement in functional neurological outcome and shortened hospitalization time.