Prehospital hypoxia affects outcome in patients with traumatic brain injury

A prospective multicenter study

John H. Chi, M. Margaret Knudson, Mary J. Vassar, Mary C. McCarthy, Michael B. Shapiro, Susan Mallet, John Holcroft, Hugh Moncrief, Jennifer Noble, David H Wisner, Krista L. Kaups, Lynn D. Bennick, Geoffrey T. Manley

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

BACKGROUND: The goals of this study were to determine the incidence and duration of hypotension and hypoxia in the prehospital setting in patients with potentially survivable brain injuries, and to prospectively examine the association of these secondary insults with mortality and disability at hospital discharge. METHODS: Trauma patients with suspected brain injuries underwent continuous blood pressure and pulse oximetry monitoring during helicopter transport. Postadmission inclusion criteria were (1) diagnosis of acute traumatic brain injury (TBI) confirmed by computed tomography (CT) scan, operative findings, or autopsy findings; and (2) Head Abbreviated Injury Scale (AIS) score of ≥3 or Glasgow Coma Scale (GCS) score of ≤12 within the first 24 hours of admission. Patients were excluded with (1) no abnormal intracranial findings on the patient's CT scan; (2) determination of a nonsurvivable injury (based on an AIS score of 6 for any body region; or, (3) death in less than 12 hours after injury. Primary outcome measures included mortality and Disability Rating Scale score at discharge. RESULTS: We enrolled 150 patients into the study. Fifty-seven patients had at least one secondary insult; 37 had only hypoxic episodes, 14 had only hypotensive episodes, and 6 patients had both. Demographics and injury characteristics did not differ between those with and those without secondary insults. The mortality for patients without secondary insults was 20%, compared with 37% for patients with hypoxic episodes, 8% for patients with hypotensive episodes, and 24% for patients with both. The Disability Rating Scale score at discharge was significantly higher in patients with secondary insults. Using multivariate analysis, the calculated odds ratio of mortality caused by prehospital hypoxia after head injury was 2.66 (p < 0.05). CONCLUSIONS: Secondary insults after TBI are common, and these insults are associated with disability. Hypoxia in the prehospital setting significantly increases the odds of mortality after brain injury controlled for multiple variables.

Original languageEnglish (US)
Pages (from-to)1134-1141
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume61
Issue number5
DOIs
StatePublished - Nov 2006

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Multicenter Studies
Prospective Studies
Brain Injuries
Abbreviated Injury Scale
Mortality
Wounds and Injuries
Craniocerebral Trauma
Hypoxia
Traumatic Brain Injury
Tomography
Body Regions
Glasgow Coma Scale
Oximetry
Aircraft
Hypotension
Autopsy
Multivariate Analysis
Odds Ratio
Demography
Outcome Assessment (Health Care)

Keywords

  • Hypoxia
  • Outcome
  • Prehospital
  • Prospective study
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

Prehospital hypoxia affects outcome in patients with traumatic brain injury : A prospective multicenter study. / Chi, John H.; Knudson, M. Margaret; Vassar, Mary J.; McCarthy, Mary C.; Shapiro, Michael B.; Mallet, Susan; Holcroft, John; Moncrief, Hugh; Noble, Jennifer; Wisner, David H; Kaups, Krista L.; Bennick, Lynn D.; Manley, Geoffrey T.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 61, No. 5, 11.2006, p. 1134-1141.

Research output: Contribution to journalArticle

Chi, JH, Knudson, MM, Vassar, MJ, McCarthy, MC, Shapiro, MB, Mallet, S, Holcroft, J, Moncrief, H, Noble, J, Wisner, DH, Kaups, KL, Bennick, LD & Manley, GT 2006, 'Prehospital hypoxia affects outcome in patients with traumatic brain injury: A prospective multicenter study', Journal of Trauma - Injury, Infection and Critical Care, vol. 61, no. 5, pp. 1134-1141. https://doi.org/10.1097/01.ta.0000196644.64653.d8
Chi, John H. ; Knudson, M. Margaret ; Vassar, Mary J. ; McCarthy, Mary C. ; Shapiro, Michael B. ; Mallet, Susan ; Holcroft, John ; Moncrief, Hugh ; Noble, Jennifer ; Wisner, David H ; Kaups, Krista L. ; Bennick, Lynn D. ; Manley, Geoffrey T. / Prehospital hypoxia affects outcome in patients with traumatic brain injury : A prospective multicenter study. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 61, No. 5. pp. 1134-1141.
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AU - Shapiro, Michael B.

AU - Mallet, Susan

AU - Holcroft, John

AU - Moncrief, Hugh

AU - Noble, Jennifer

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KW - Traumatic brain injury

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