title: Severe traumatic brain injury: consequences of early adverse events.
abstract: BACKGROUND
  Several factors associated with an unfavourable outcome after severe traumatic brain injury (TBI) have been described: prolonged pre-hospital time, secondary referral to a level 1 trauma centre, the occurrence of secondary insults such as hypoxia, hypotension or low end-tidal carbon dioxide (ETCO(2)). To determine whether adverse events were linked to outcome, patients with severe TBI were studied before arrival at a level 1 trauma centre.
  
  
  METHODS
  Prospective, observational study design. Patients with severe TBI (n = 48), admitted to Umeå University Hospital between January 2002 to December 2005 were included. All medical records from the site of the accident to arrival at the level 1 trauma centre were collected and evaluated.
  
  
  RESULTS
  A pre-hospital time of >60 min, secondary referral to a level 1 trauma centre, documented hypoxia (oxygen saturation <95%), hypotension (systolic blood pressure <90 mmHg), hyperventilation (ETCO(2) <4.5 kPa) or tachycardia (heart rate >100 beats/min) at any time before arrival at a level 1 trauma centre were not significantly related to an unfavourable outcome (Glasgow Outcome Scale 1-3).
  
  
  CONCLUSIONS
  Early adverse events before arrival at a level 1 trauma centre were without significance for outcome after severe TBI in the trauma system studied.
authors.affiliation: Department of Anaesthesia and Intensive Care, Institution of Surgery and Perioperative Sciences, Umeå University, Sweden. camilla.brorsson@anestesi.umu.se
authors.forename: C
authors.initials: C
authors.lastname: Brorsson
authors.forename: M
authors.initials: M
authors.lastname: Rodling-Wahlström
authors.forename: M
authors.initials: M
authors.lastname: Olivecrona
authors.forename: L-O D
authors.initials: LO
authors.lastname: Koskinen
authors.forename: S
authors.initials: S
authors.lastname: Naredi
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy; D010100:Oxygen / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D014187:Transportation of Patients; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen