An evaluation of the use of guidelines in prehospital management of brain injury.
OBJECTIVE
The Brain Trauma Foundation (BTF) Guidelines for Prehospital Management of Traumatic Brain Injury (TBI) are intended to standardize treatment and improve outcomes in severe TBI patients. The key guideline components focus on airway management, blood pressure support, Glasgow Coma Score assessment, and transport. The purposes of this study were to determine if providers could learn and retain the guidelines (education), assess if providers would use the guidelines in practice (implementation), and evaluate the effect of guideline implementation on patients (outcomes).


METHODS
Data were collected prospectively on all trauma patients for five months. Providers were then educated on the TBI guidelines over two months, and five additional months of data were collected. A knowledge test was given before and after the course and three months later to assess education. To assess implementation, data were analyzed to determine whether providers were using the key interventions more consistently after education. The clinical courses of TBI patients before and after guideline implementation were measured to assess outcomes.


RESULTS
Knowledge of TBI care improved significantly after education and remained elevated at three months (62% vs. 82% vs. 79%, p < 0.001). For the 1,044 patients seen, providers demonstrated higher rates of appropriate care, resulting in lower rates of hypoxia (2.8% vs. 1.1%, p=0.010) and hypotension (4.8% vs. 2.0%, p=0.018). Mortality was significantly decreased (34.6% vs. 17.0%, p=0.039), and rates of patients with maximum functional scores at 14 days significantly increased (Glasgow Outcome Score 44.2% vs. 66.0%, p=0.025; Rancho Los Amigos Scale 55.9% vs. 77.3%, p=0.045).


CONCLUSIONS
Providers were able to learn and implement the BTF guidelines, and outcomes in TBI patients were significantly improved. All emergency medical services providers should be trained in these potentially lifesaving guidelines.
Inova Research Center, Inova Fairfax Hospital, Falls Church, Virginia 22042-3300, USA. dorrainewatts@hotmail.com
Dorraine D
DD
Watts
Dan
D
Hanfling
Maureen A
MA
Waller
Colleen
C
Gilmore
Samir M
SM
Fakhry
Arthur L
AL
Trask
D000328:Adult; D001930:Brain Injuries / Q000628:therapy*; D004632:Emergency Medical Services / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D008297:Male; D009511:New England; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome