title: Prehospital care in patients with severe traumatic brain injury: does the level of prehospital care influence mortality?
abstract: OBJECTIVE
  The controversy between the "scoop and run" versus the "stay and play" approach in severely injured trauma patients has been an ongoing issue for decades. The present study was undertaken to investigate whether changes in prehospital care for patients with severe traumatic brain injury in the Netherlands have improved outcome.
  
  
  METHODS
  In this retrospective study, files (n = 60) were analyzed from a prospectively collected database including all patients admitted to one of six hospitals in the Limburg region in the Netherlands with a Glasgow Coma Scale (GCS) score ≤8 on admittance over the period from January 2006 to December 2008. All patients had traumatic brain damage proven on computed tomography (CT) or magnetic resonance imaging (MRI). Relevant prehospital and clinical data from the present cohort were compared to data from a similar study (n = 30) conducted 20 years ago. The primary outcome assessed was mortality.
  
  
  RESULTS
  The two study groups had similar characteristics with regard to the GCS score. In the historic cohort, Basic Life Support (BLS) and the "scoop and run" approach in patients with major traumatic brain injury was common, with an average time on scene of 7.5 min. Currently, prehospital care is performed mainly on the level of prehospital Advanced Life Support (ALS), with the average time on scene being about four times as long as in the historic cohort. However, the overall mortality rate for the current cohort compared to the historic cohort has not changed.
  
  
  CONCLUSIONS
  Despite more on-site ALS in severely head injured patients nowadays compared to the historic cohort, there was no reduction in mortality.
authors.affiliation: Network Acute Care Limburg, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: M M F
authors.initials: MM
authors.lastname: Aubuchon
authors.affiliation: Network Acute Care Limburg, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. b.hemmes@mumc.nl.|, Bogaartsborg 3, 6228 AK, Maastricht, The Netherlands. b.hemmes@mumc.nl.
authors.forename: B
authors.initials: B
authors.lastname: Hemmes
authors.affiliation: Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Poeze
authors.affiliation: Department of Anaesthesiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Jansen
authors.affiliation: Network Acute Care Limburg, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.|Department of Surgery, University Hospital Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: P R G
authors.initials: PR
authors.lastname: Brink
keywords: Advanced Life Support; Basic Life Support; Mortality; Prehospital care; Traumatic brain injury
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