title: Has increased nursing competence in the ambulance services impacted on pre-hospital assessment and interventions in severe traumatic brain-injured patients?
abstract: OBJECTIVE
  Trauma is one of the most common causes of morbidity and mortality in modern society, and traumatic brain injuries (TBI) are the single leading cause of mortality among young adults. Pre-hospital acute care management has developed during recent years and guidelines have shown positive effects on the pre-hospital treatment and outcome for patients with severe traumatic brain injury. However, reports of impacts on improved nursing competence in the ambulance services are scarce. Therefore, the aim of this study was to investigate if increased nursing competence level has had an impact on pre-hospital assessment and interventions in severe traumatic brain-injured patients in the ambulance services.
  
  
  METHODS
  A retrospective study was conducted. It included all severe TBI patients (>15 years of age) with a Glasgow Coma Score (GCS) of less than eight measured on admission to a level one trauma centre hospital, and requiring intensive care (ICU) during the years 2000-2009.
  
  
  RESULTS
  651 patients were included, and between the years 2000-2005, 395 (60.7%) severe TBI patients were injured, while during 2006-2009, there were 256 (39.3%) patients. The performed assessment and interventions made at the scene of the injury and the mortality in hospital showed no significant difference between the two groups. However, the assessment of saturation was measured more frequently and length of stay in the ICU was significantly less in the group of TBI patients treated between 2006-2009.
  
  
  CONCLUSIONS
  Greater competence of the ambulance personnel may result in better assessment of patient needs, but showed no impact on performed pre-hospital interventions or hospital mortality.
authors.affiliation: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, III, 141 83 Huddinge, Stockholm, Sweden. ann-charlotte.falk@ki.se.
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Falk
authors.forename: Annika
authors.initials: A
authors.lastname: Alm
authors.forename: Veronica
authors.initials: V
authors.lastname: Lindström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057184:Practice Patterns, Nurses' / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult