Évaluation de la régulation préhospitalière et prise en charge initiale des traumatisés crâniens graves dans la région des Pays-de-la-Loire: Étude prospective, multicentrique

Abstract: Objective: To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005. Study design: Prospective and multicenter. Patients and methods: All patients managed by Samu with GCS≤8 on the field, starting from a GCS≤10. Results: We report on 125 patients (88% of all SHIP managed in 2005), including 114 with a GCS less or equal to eight on which analysis was performed: age: 37±20 years, men: 4/1, road accident: 73%, fall: 20%, (polytrauma: 53%, artificial ventilation: 92%). Delays: field medical care 54±28min, transportation: 32±29min, total time to hospital: 1h55±48min. Direct admission in a center with neurosurgery on site: 68%; 47% of patients admitted in general hospitals were transferred to a tertiary hospital (71% to neurosurgery). Mortality before 24th hour (23%) was associated (p <0.05) with shorter transfer time, older patient, persistent shock, fluid loading greater than 1500ml, continuous infusion of vasopressors, focal neurological deficit. Problems were reported by Samu teams (21% of cases): medical care (32%), emergency ambulance availability (20%), alerting process (16%), on field care before Samu (12%). Of note, mannitol was never used, despite a mydriasis. Conclusion: We observed a delayed referral of patients to a tertiary hospital, a limited use of CT image transmission and the absence of mannitol administration but also organisational problems reported in 21% of cases problems are main target for quality improvement. [Copyright &y& Elsevier]