Abstract
Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out based on limited clinical diagnostics. Potential new mobile diagnostics may decrease these errors. Prehospital care includes decision-making in clinical pathways, means of transport, and the degree of prehospital treatment. Emergency care at hospital admission includes the definitive diagnosis of TBI with, or without extracranial lesions, and triage to the appropriate receiving structure for definitive care. Early risk factors for an unfavorable outcome includes the severity of TBI, pupil reaction and age. These three variables are core variables, included in most predictive models for TBI, to predict short-term mortality. Additional early risk factors of mortality after severe TBI are hypotension and hypothermia. The extent and duration of these two risk factors may be decreased with optimal prehospital and emergency care. Potential new avenues of treatment are the early use of drugs with the capacity to decrease bleeding, and brain edema after TBI. There are still many uncertainties in prehospital and emergency care for TBI patients related to the complexity of TBI patterns.
Highlights
Traumatic brain injury (TBI) is a major cause of death and disability, and was identified as a major healthcare problem that affects 10 million people per year worldwide, males [1]
In a Swedish cohort study, including 305,885 men conscripted for military service from 1989 to 1994, the independent risk factors found for mild TBI were low cognitive function, intoxication, and low socioeconomic status [19]
A study of major traumatic brain injury found that the depth, and duration of out-of-hospital hypotension were strongly associated with increased mortality [49]
Summary
Traumatic brain injury (TBI) is a major cause of death and disability, and was identified as a major healthcare problem that affects 10 million people per year worldwide, males [1]. TBI trauma mechanisms shifted from road traffic accidents and outdoor trauma, to indoor trauma and falls [5] These changes in trauma mechanisms leading to TBI are associated with demographic changes in the general population, with more elderly people in industrialized countries [8]. The cognitive, mental, and physical impairment in survivors after TBI may result in a major burden for families and societies This long-term morbidity of TBI is associated with a huge financial. TBI was 36,648 $, and the lifetime cost of all TBI survivors was 147 million $ [9] The aim of this narrative review was to summarize the limited evidence supporting the practice of prehospital and early emergency care at hospital admission after acute TBI. This review can support a critical appraisal of local prehospital care, in particular, prehospital care of elderly patients with acute TBI
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