Neuroanesthesia & neurocritical care
Adverse Prehospital Events and Outcomes After Traumatic Brain Injury
Authors' conclusion
In this multicenter cohort study, prehospital hypoxia, hypotension, and hypocarbia were associated with poorer TBI outcomes.
Study context
- Population
- Adults (≥18 years) with confirmed traumatic brain injury (TBI) (head AIS 1–6) and Injury Severity Score (ISS) ≥9, Linking Investigations in Trauma and Emergency Services (LITES) Network, 2017–2021; interfacility transfers and prehospital CPR excludedanalytic cohort
- Participants
- 14,994 adults
- Exposure
- Prehospital hypoxia, hypotension or hypocarbia vs no such adverse event
- Hypoxian = 1,577
- Hypotensionn = 1,426
- Hypocarbian = 650
- Outcome
- Death in the ED, hospital death, and unfavorable discharge disposition
Methodological details8 level I trauma centers and affiliated emergency medical services (EMS) agencies
- 8 level I trauma centers and affiliated EMS agencies
Main finding
As reported in the abstract
Death in the ED
Adjusted relative risk (95% CI)
Hypoxia
2.24(1.69–2.97)
Hypotension
2.05(1.54–2.72)
Hypocarbia
7.99(2.47–25.85)
- Death in the emergency department (ED), overall cohort
- 2% (259 of 14 939)
Observational data: associations, not effects.
Further findings
- Hospital death, overall cohort
- 12% (1764 of 14 623)
- Unfavorable discharge disposition, overall cohort
- 25% (3705 of 14 623)
- Each adverse TBI event associated with higher risks of hospital death and unfavorable discharge disposition
Original publication
Adverse Prehospital Events and Outcomes After Traumatic Brain Injury. JAMA Netw Open. Published 2 January 2025. doi:10.
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