title: Factors that may improve outcomes of early traumatic brain injury care: prospective multicenter study in Austria.
abstract: BACKGROUND
  Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participating emergency medical services and hospitals and evaluated for their effect.
  
  
  METHODS
  14 Austrian centers treating TBI patients participated in the study. Between 2009 and 2012 all patients with Glasgow Coma Scale score < 13 and/or AIS head > 2 within 48 h after the accident, were enrolled. Data were collected in 2 phases: in the first phase data of 408 patients were analyzed. Based on this, a set of recommendations expected to improve outcomes was developed by the study group and implemented in participating centers. Recommendations included time factors (transport to appropriate trauma center, avoiding secondary transfer), adequate treatment strategies (prehospital fluid and airway management, anesthesia, ventilation), monitoring (pulse oximetry and blood pressure monitoring in all patients, capnography in ventilated patients) for prehospital treatment. In the emergency department focus was on first CT scan as soon as possible, short interval between CT scan and surgery and early use of thrombelastometry to optimize coagulation. Following implementation of these recommendations, data on 325 patients were collected and analyzed in phase 2. Final analysis investigated the impact of the recommendations on patient outcomes.
  
  
  RESULTS
  Patients in both data collection phases showed comparable demographic and injury severity characteristics. Treatment changes, especially in terms of fluid management, monitoring and normoventilation as well as thrombelastometry measurements were implemented successfully in phase 2, and led to significant improvement of patient outcomes. Hospital mortality was reduced from 31 % to 23 %. We found a lower rate of unfavorable outcomes, a significant increase in unexpected survivors and more patients with unexpected favorable outcomes as well.
  
  
  CONCLUSIONS
  The results of this study clearly demonstrate that the outcomes of TBI patients can be improved with appropriate early care.
authors.affiliation: International Neurotrauma Research Organization (INRO), Mölker Gasse 4/3, 1080, Vienna, Austria. abrazinova@igeh.org.|Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Univerzitne nam.1, 91843, Trnava, Slovak Republic. abrazinova@igeh.org.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Brazinova
authors.affiliation: International Neurotrauma Research Organization (INRO), Mölker Gasse 4/3, 1080, Vienna, Austria. mmajdan@igeh.org.|Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Univerzitne nam.1, 91843, Trnava, Slovak Republic. mmajdan@igeh.org.
authors.forename: Marek
authors.initials: M
authors.lastname: Majdan
authors.affiliation: Department of Traumatology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. johannes.leitgeb@meduniwien.ac.at.
authors.forename: Johannes
authors.initials: J
authors.lastname: Leitgeb
authors.affiliation: Department of Anesthesiology, Intensive Care and Emergency Medicine, Wiener Neustadt Regional Hospital, Corvinusring 3-5, 2700, Wiener Neustadt, Austria. Helmut.Trimmel@wienerneustadt.lknoe.at.
authors.forename: Helmut
authors.initials: H
authors.lastname: Trimmel
authors.affiliation: International Neurotrauma Research Organization (INRO), Mölker Gasse 4/3, 1080, Vienna, Austria. walter.mauritz@auva.at.|Department of Anesthesiology and Intensive Care Medicine, Trauma Hospital 'Lorenz Boehler", Donaueschingenstraße 13, 1200, Vienna, Austria. walter.mauritz@auva.at.
authors.forename: Walter
authors.initials: W
authors.lastname: Mauritz
mesh_terms: D000328:Adult; D001317:Austria / Q000453:epidemiology; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D014193:Trauma Centers; D055815:Young Adult