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INTRODUCTION Polytrauma and traumatic brain injury (TBI) patients are among the most vulnerable patients in trauma care and exhibit increased morbidity and mortality. Timely care is essential for their outcome. Severe TBI with initially high scores on the Glasgow Coma (GCS) scores is difficult to recognise on scene and referral to a Major Trauma Center (MTC) might be delayed. Therefore, we examined current referral practice, injury patterns and mortality in these patients. MATERIALS AND METHODS Retrospective, nationwide cohort study with Swiss Trauma Register (STR) data between 01/012015 and 31/12/2018. STR includes patients ≥16 years with an Injury Severity Score (ISS) >15 and/or an Abbreviated Injury Scale (AIS) for head >2. We performed Cox proportional hazard models with injury type as the primary outcome and mortality as the dependent variable. Secondary outcomes were inter-hospital transfer and age. RESULTS 9,595 patients were included. Mortality was 12%. 2,800 patients suffered from isolated TBI. 69% were men. Median age was 61 years and median ISS 21. Two thirds of TBI patients had a GCS of 13-15 on admission to the Emergency Department (ED). 26% of patients were secondarily transferred to an MTC. Patients with isolated TBI and those aged ≥65 years were transferred more often. Crude analysis showed a significantly elevated hazard for death of 1.48 (95%CI 1.28-1.70) for polytrauma patients with severe TBI and a hazard ratio (HR) of 1.82 (95%CI 1.58-2.09) for isolated severe TBI, compared to polytrauma patients without TBI. Patients directly admitted to the MTC had a significantly elevated HR for death of 1.63 (95%CI 1.40-1.89), compared to those with secondary transfer. CONCLUSIONS A high initial GCS does not exclude the presence of severe TBI and triage to an MTC should be seriously considered for elderly TBI patients.

Questions under study/principles: Analysis of changes in the behaviour of wearing protective equipment by alpine skiers and snowboarders after injury, performed at a level I trauma centre in Switzerland. Methods: We present a study, using a standardised questionnaire, assessing behaviour on ski slopes by adult patients admitted between Oct 2007 and April 2008. Patients were re-interviewed after the 2008/2009 season. McNemar tests were used to analyse differences in protective clothing wearing rates between the two seasons. Multiple logistic regression with age, gender and injury severity score (ISS) as predictors, was used to compare findings in those who started wearing protective equipment and those who did not. Results: A total of 104/132 patients from the 2007/2008 season were questioned about wearing protective equipment in 2008/2009. 20 patients could not be reassessed (7 declined, 13 had abandoned winter sports). A total of 84 patients were reassessed (61 alpine skiers and 23 snowboarders). The median age of participants was 39 years and 70.2% were male. Helmet and back protector wearing rates increased from 40.5% to 78.6% (p <0.001) and from 14.3% to 23.8% (p = 0.021), respectively. Snowboarders more than doubled their helmet wearing rate (39.1% to 82.6%, p = 0.002). Skiers showed a trend towards doubling their back protector wearing rate (6.6% to 14.8%, p = 0.063). Younger skiers started wearing back protectors more often than older skiers. Conclusions: Sustained injury might provide skiers and snowboards with a potent trigger to change their attitude towards the use of protective equipment. The psychological processes influencing the use of protective equipment require further investigation.