Efficacy of prehospital critical care teams for severe blunt head injury in the Australian setting.
OBJECTIVE
To determine whether prehospital critical care teams (CCT) would result in improved functional outcomes for road trauma related severe head injury in the Australian setting, when compared with standard advanced life support measures provided by paramedics.


METHODS
Retrospective review of 250 patients treated by paramedics and 46 patients treated by CCT transported directly from the accident scene, with a prehospital Glasgow coma scale (GCS)< or =8.


RESULTS
CCT-treated patients had longer median prehospital times (113 versus 45 min, P<0.001), and a higher prehospital intubation rate (100% versus 36%, P<0.001) than paramedic-treated patients. On multivariate analysis, revised trauma score > or =4.45 (odds ratio [OR] 2.31, 95% CI: 1.15-4.65), lower injury severity score (OR 1.04, 95% CI: 1.02-1.06), age< or =25 years (OR 1.76, 95% CI: 1.13-2.75), absence of an acute subdural haematoma (OR 3.36, 95% CI: 1.89-5.95) and prehospital treatment by a CCT (OR 2.70, 95% CI: 1.48-4.95) independently predicted better outcome.


CONCLUSIONS
The range of advanced interventions provided by the CCT were associated with improved functional outcome. Further studies are required to determine the individual factors responsible.
Garner
A
A
NRMA CareFlight/NSW Medical Retrieval Service, PO Box 159, 2145, Westmead, Australia. alang@careflight.org
Crooks
J
J
Lee
A
A
Bishop
R
R
D000063:Accidents, Traffic; D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D003422:Critical Care / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009517:New South Wales; D016017:Odds Ratio; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome