title: Effect of secondary prehospital risk factors on outcome in severe traumatic brain injury in the context of fast access to trauma care.
abstract: BACKGROUND
  Prevention of secondary prehospital risk factors such as hypoxia and hypotension is likely to improve patient prognosis in severe traumatic brain injury (TBI). Because the Dutch trauma care organization is characterized by fast access to specialized trauma care due to the geographical situation, we investigated whether and to what extend secondary risk factors, such as hypoxia and hypotension, and measures, such as endotracheal intubation, affect outcome in severe TBI in the context of a region with fast access to trauma care.
  
  
  METHODS
  The medical records of 339 subsequent computed tomography-confirmed patients with TBI with a Glasgow coma scale (GCS) score≤8 who were primarily referred to a Level I trauma center in Amsterdam or Nijmegen in the Netherlands were retrospectively analyzed.
  
  
  RESULTS
  Multinomial logistic regression revealed that the strongest outcome predictors in our population were a disturbed pupillary reflex (odds ratio [OR], 5.8), a GCS score of 3 (OR, 4.9), and arterial hypotension (OR, 3.5). Interestingly, we observed no differences between intubated and nonintubated patients with respect to metabolic and respiratory parameters or mortality whereby the injury severity score was slightly higher in endotracheally intubated patients (32 [25-41]) versus nonintubated patients (25 [22-29]).
  
  
  CONCLUSIONS
  In agreement with others, GCS, a disturbed pupil reflex, and arterial hypotension were predictive for the prognosis of primarily referred patients with severe TBI in the Netherlands. In contrast, in the perspective of slightly higher injury scores in intubated patients, prehospital endotracheal intubation was not predictive for patient outcome.
authors.affiliation: Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands. g.franschman@vumc.nl
authors.forename: Gaby
authors.initials: G
authors.lastname: Franschman
authors.forename: Saskia M
authors.initials: SM
authors.lastname: Peerdeman
authors.forename: Teuntje M J C
authors.initials: TM
authors.lastname: Andriessen
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Greuters
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Toor
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Vos
authors.forename: Fred C
authors.initials: FC
authors.lastname: Bakker
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Loer
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
mesh_terms: D000328:Adult; D058109:Airway Management; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D015600:Glasgow Coma Scale; D006297:Health Services Accessibility; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D015601:Injury Severity Score; D008297:Male; D009426:Netherlands; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers