title: Study protocol for the PHANTOM study: prehospital assessment of noninvasive tissue oximetry monitoring.
abstract: BACKGROUND
  Traumatic brain injury is a major cause of mortality and morbidity worldwide. It can be worsened by secondary injury particularly with hypoxia or hypotension. Current prehospital guidelines emphasise regular measurement of peripheral oxygen saturation and blood pressure but there is no monitor in use to provide direct information relating to blood flow or oxygen delivery to the brain tissue. This prospective cohort study will assess the utility of near-infrared spectroscopy monitoring in prehospital medicine in demonstrating injury, pathophysiology and associations with long-term functional outcomes.
  
  
  METHODS
  A prospective cohort study will be conducted in prehospital services where physician/paramedic teams respond rapidly to patients suffering significant traumatic injuries. A study observer accompanying the clinical team will apply non-invasive near-infrared spectroscopy tissue oximetry using a Nonin EQUANOX 7610 Regional Oximetry monitor (TM Nonin Medical, Inc.). This will be applied to patients with traumatic injuries less than 30 minutes old requiring transport. Measurements will be taken at two sites on the forehead and one on the forearm. Clinical teams will be blinded to all monitoring values. Near-infrared spectroscopy tissue oximetry parameters of oxyhaemoglobin%, deoxyhaemoglobin%, total tissue haemoglobin index and regional oxygen saturation will be recorded. Separate statistical analysis relating to time spent with cerebral regional oxygen saturation values < 45% and time series analysis will be performed to demonstrate associations with acute phase outcomes including injuries seen on cerebral imaging, and long-term functional outcomes measured by Glasgow Outcome Score and Extended Glasgow Outcome Score will then be undertaken.
  
  
  CONCLUSIONS
  This prospective cohort study will demonstrate associations evident from the earliest stages of prehospital treatment between near-infrared spectroscopy tissue oximetry values and both acute and long-term outcomes of patients suffering traumatic injuries. This may provide the basis for future interventional studies utilising near-infrared spectroscopy tissue oximetry to guide prehospital trauma care.
  
  
  BACKGROUND
  This trial is registered with the Australian and New Zealand Clinical Trials Registry. The registration number is ACTRN12611001124921 .
authors.affiliation: CareFlight, Westmead, NSW, Australia. andrew.weatherall@careflight.org.|The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia. andrew.weatherall@careflight.org.|The University of Sydney, Westmead, NSW, 2145, Australia. andrew.weatherall@careflight.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Weatherall
authors.affiliation: CareFlight, Westmead, NSW, Australia. alan.garner@careflight.org.|The University of Sydney, Westmead, NSW, 2145, Australia. alan.garner@careflight.org.
authors.forename: Alan
authors.initials: A
authors.lastname: Garner
authors.affiliation: The University of New South Wales, Randwick, NSW, 2031, Australia. n.lovell@unsw.edu.au.
authors.forename: Nigel
authors.initials: N
authors.lastname: Lovell
authors.affiliation: The University of New South Wales, Randwick, NSW, 2031, Australia. s.redmond@unsw.edu.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Redmond
authors.affiliation: The Chinese University of Hong Kong, Shatin, NT, Hong Kong. anna.lee@cuhk.edu.hk.
authors.forename: Anna
authors.initials: A
authors.lastname: Lee
authors.affiliation: The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia. justin.skowno@health.nsw.gov.au.|The University of Sydney, Westmead, NSW, 2145, Australia. justin.skowno@health.nsw.gov.au.
authors.forename: Justin
authors.initials: J
authors.lastname: Skowno
authors.affiliation: The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia. jonathan.egan@health.nsw.gov.au.|The University of Sydney, Westmead, NSW, 2145, Australia. jonathan.egan@health.nsw.gov.au.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Egan
mesh_terms: D000328:Adult; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000175:diagnosis* / Q000378:metabolism; D004632:Emergency Medical Services / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*
chemical_list: D010100:Oxygen