|About the Book|
Traumatic brain injuries account for 1.5 million injuries and approximately 52,000 deaths in the United States per year. The prehospital management of traumatic brain injured patients is a critical link to patient outcomes. The Brain TraumaMoreTraumatic brain injuries account for 1.5 million injuries and approximately 52,000 deaths in the United States per year. The prehospital management of traumatic brain injured patients is a critical link to patient outcomes. The Brain Trauma Foundation (BTF) has published evidence-based guidelines for airway and ventilation management.-The purpose of this retrospective study was to determine if prehospital endotracheal intubation and controlled ventilation of traumatic brain injured adult patients was consistent with the BTF Hyperventilation Guideline and resulted in (a) the avoidance of hypocarbia upon hospital admission, (b) fewer incidents of secondary brain injury insults 24, 48, 72, and 96 hours post injury in the intensive care unit and (c) better patient outcomes, as measured on the Glasgow Outcome Scale (GOS).-Registry data was used to examine 100 cases and the relationship between the primary independent variable, prehospital end-tidal carbon dioxide (ETCO 2) and selected dependent demographic variables and traumatic injury outcomes (Glasgow Coma Scale [GCS], Abbreviated Injury Score for head, Injury Severity Score, Revised Trauma Score and Trauma Injury Severity Score). Physiological measures of secondary brain injury (PaO2, mean arterial pressure, pH, GCS, intracranial pressure, international normalized ratio and temperature) were included.-Students t-tests, with 95% confidence intervals, were used to compare study groups for age and trauma outcome scores. The adherence rate was 65% and characterized by a statistically significant younger age (p = 0.02). Trauma Score Injury Severity Scores were statistically significantly higher in the adherent group (p = 0.01), indicating a higher probability of survival. No other trauma measures differed significantly between the groups. A 2-factor repeated measures analysis-of-variance was used to examine changes over time between groups for physiologic measures. The data analysis did not reveal new clinically relevant trends. Correlational analysis was used to examine the association between GOS and prehospital ETCO 2 level, no association was found. An association emerged between hospital ETCO2 and GOS. In addition, the difference in mortality between the two groups was analyzed. The mortality risk in the adherent ETCO2 group was less in comparison to the non-adherent group.