Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients.
Our aim was to assess the occurrence of secondary insults (SIs) or adverse events (AEs) during intrahospital transport (IHT) of severe traumatic brain injury (TBI) patients for head computed tomography (CT) scanning.



A prospective study based on severe TBI patients admitted from June 2011 through June 2013 in a level I trauma center. Patients received an IHT to perform a control CT scan in the first 3 days following trauma. The occurrence of SIs and AEs was assessed during the IHT for a control CT scan. The frequency of SIs was compared to the periods "before," "during," and "after" IHT. SI was defined by an intracranial pressure (ICP) >30 mmHg, a cerebral perfusion pressure (CPP) <50 mmHg, systolic blood pressure (SBP) <90 mmHg, or saturation pulse O2(SpO2) <90 % for more than five consecutive minutes. An AE was defined as failures of hardware or ventilator asynchrony requiring therapeutic intervention during transport. In addition, we assessed the therapeutic benefit of a CT scan control.



The final analysis included 31 patients and 31 IHTs. The median duration of IHT was 29 min [25;37]. SIs occurred in 16 patients (52 %) during transport, whereas it was observed in 4 patients (13 %) before (p = 0.002) and 4 patients (13 %) after IHT (p = 0.001). Twenty-four AEs occurred during transport of 19 patients (61 %). One patient benefited from hematoma evacuation after implementation of control CT.



IHT carries significant SIs and AEs in severe TBI patients. To improve a risk/benefit ratio favorable for patients, a program focusing on IHT complications regarding therapeutic impact of control CT scan is needed.
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. mathieu.martin@hmn.aphp.fr.
Mathieu
M
Martin
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Fabrice
F
Cook
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
David
D
Lobo
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Charlotte
C
Vermersch
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Arié
A
Attias
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Bouziane
B
Ait-Mamar
Department of Anaesthesiology and Surgical Intensive Care, Paris-Diderot University and Assistance-Publique Hôpitaux de Paris, St Louis University Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Benoît
B
Plaud
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Roman
R
Mounier
Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Gilles
G
Dhonneur
D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000706:statistics & numerical data; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data; D055815:Young Adult
Head computed tomography; Intrahospital transport; Traumatic brain injury