[Audit of the prehospital management of severe head injured patients in the "Pays-de-la-Loire" region].
OBJECTIVE
To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005.


METHODS
Prospective and multicenter.


METHODS
All patients managed by Samu with GCS</=8 on the field, starting from a GCS</=10.


RESULTS
We report on 125 patients (88% of all SHIP managed in 2005), including 114 with a GCS less or equal to eight on which analysis was performed: age: 37+/-20 years, men: 4/1, road accident: 73%, fall: 20%, (polytrauma: 53%, artificial ventilation: 92%). Delays: field medical care 54+/-28 min, transportation: 32+/-29 min, total time to hospital: 1 h 55+/-48 min. Direct admission in a center with neurosurgery on site: 68%; 47% of patients admitted in general hospitals were transferred to a tertiary hospital (71% to neurosurgery). Mortality before 24th hour (23%) was associated (p<0.05) with shorter transfer time, older patient, persistent shock, fluid loading greater than 1500 ml, continuous infusion of vasopressors, focal neurological deficit. Problems were reported by Samu teams (21% of cases): medical care (32%), emergency ambulance availability (20%), alerting process (16%), on field care before Samu (12%). Of note, mannitol was never used, despite a mydriasis.


CONCLUSIONS
We observed a delayed referral of patients to a tertiary hospital, a limited use of CT image transmission and the absence of mannitol administration but also organisational problems reported in 21% of cases problems are main target for quality improvement.
Bouhours
G
G
Pôle d'anesthésie réanimation, CHU d'Angers, 49933 Angers cedex 9, France. gubouhours@chu-angers.fr
Lehousse
T
T
Mylonas
J
J
Lacroix
G
G
Gondret
C
C
Savio
C
C
Couillard
C
C
Beydon
L
L
D000328:Adult; D006259:Craniocerebral Trauma / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D005602:France; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008485:Medical Audit