Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores.

Francisco Martín-Rodríguez,Jesús Gómez Correas,José Luis Martín-Conty,Gonçalo Marques,Antonio Viñuela,Clara Maestre Miquel,Begoña Polonio-López,Carlos Durantez Fernández,Alicia Mohedano-Moriano,Raúl López-Izquierdo

doi:10.3390/ijerph17051504

Abstract

Traumatic brain injuries are complex situations in which the emergency medical services must quickly determine the risk of deterioration using minimal diagnostic methods. The aim of this study is to analyze whether the use of early warning scores can help with decision-making in these dynamic situations by determining the patients who need the intensive care unit. A prospective, multicentric cohort study without intervention was carried out on traumatic brain injury patients aged over 18 given advanced life support and taken to the hospital. Our study included a total of 209 cases. The total number of intensive-care unit admissions was 50 cases (23.9%). Of the scores analyzed, the National Early Warning Score2 was the best result presented with an area under the curve of 0.888 (0.81–0.94; p < 0.001) and an odds ratio of 25.4 (95% confidence interval (CI):11.2–57.5). The use of early warning scores (and specifically National Early Warning Score2) can help the emergency medical services to differentiate traumatic brain injury patients with a high risk of deterioration. The emergency medical services should use the early warning scores routinely in all cases for the early detection of high-risk situations.

Highlights

The incidence of patients with traumatic brain injury (TBI) in industrialised countries is approximately 200/100,000 inhabitants/year [1], representing one of the most common causes of permanent damage; around 10%–20% of cases are severe and usually require the intensive-care unit (ICU), presenting high mortality [2,3]
The main aim of this study is to compare the diagnostic accuracy of four early warning scores (EWS) commonly used in a prehospital setting for the early detection of TBI to specify the need for ICU, and secondarily:
The difference between patients admitted to the ICU and those not requiring ICU was significant for all the variables studied with the exception of age, breathing rate, temperature and blood glucose (Table 2)

Summary

Introduction

The incidence of patients with traumatic brain injury (TBI) in industrialised countries is approximately 200/100,000 inhabitants/year [1], representing one of the most common causes of permanent damage; around 10%–20% of cases are severe and usually require the intensive-care unit (ICU), presenting high mortality [2,3]. The current epidemiological pattern includes traffic accidents, followed by work-related accidents, falls and deliberate self-harm [4]. TBIs are complex situations that can clearly benefit from prehospital care [5]. Advanced trauma life-support actions, developed at the scene or en route, decisively contribute to avoiding brain. Res. Public Health 2020, 17, 1504; doi:10.3390/ijerph17041504 www.mdpi.com/journal/ijerph

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