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Isolated blunt severe traumatic brain injury in Bern, Switzerland, and the United States: A matched cohort study
- Source :
- Haltmeier, Tobias; Schnüriger, Beat; Benjamin, Elizabeth; Brodmann Maeder, Monika; Künzler, Michael; Siboni, Stefano; Inaba, Kenji; Demetriades, Demetrios (2016). Isolated blunt severe traumatic brain injury in Bern, Switzerland, and the United States: A matched cohort study. Journal of Trauma and Acute Care Surgery, 80(2), pp. 296-301. Wolters Kluwer, Lippincott Williams & Wilkins 10.1097/TA.0000000000000892
- Publication Year :
- 2015
-
Abstract
- BACKGROUND The ideal prehospital management of patients with severe traumatic brain injury (TBI) including the impact of endotracheal intubation (ETI) and physicians on scene is unclear. Prehospital management differs substantially in Switzerland and the United States: in Switzerland, there is usually a physician on scene who may provide ETI and other advanced life support procedures, whereas in the United States, prehospital management (including ETI) is performed by paramedics. METHODS This is a retrospective cohort-matched study of patients with isolated blunt severe TBI (head Abbreviated Injury Scale [AIS] score, 4-5) and no major extracranial injuries, using Bern University Hospital data from the Swiss PEBITA [Patient-relevant Endpoints after Brain Injury from Traumatic Accidents] (TBI-specific) database and the US National Trauma Data Bank from 2009 to 2010. A 1:4 cohort matching of Bern and US patients was performed. Matching criteria were sex, age (±10 years), exact field Glasgow Coma Scale (GCS) score, exact head AIS score, and injury type (subdural hematoma, epidural hematoma, intraparenchymal hemorrhage, intraventricular hemorrhage, brain edema/swelling, brain stem injury). The matched cohorts were compared with univariable analysis (Fisher's exact test and Mann-Whitney U-test). RESULTS Matching of the Bern (n = 128) and US (n = 86,375) cohort resulted in 355 matched cases (71 Bern and 284 US patients). Bern patients had significantly longer scene times (median, 23.0 minutes vs. 9.0 minutes, p < 0.001) and more frequent prehospital ETI (31.0% vs. 18.7%, p = 0.034) and air transportation (39.4% vs. 19.4%, p < 0.001). No significant difference in procedures (craniotomy/craniectomy, intracranial pressure monitoring, tracheotomy), intensive care unit and total hospital lengths of stay, ventilator days, and in-hospital mortality (14.1% vs. 15.8%, p = 0.855) was found between the two cohorts. CONCLUSION When taking into account the limitation that patient- and injury-related factors, but not in-hospital treatment variables, were matched, the more frequent prehospital ETI and presence of a physician on scene in the Swiss cohort compared with the US cohort had no significant effect on outcomes, including intensive care unit and total hospital lengths of stay, ventilator days, and in-hospital mortality. LEVEL OF EVIDENCE Therapeutic study, level IV.
- Subjects :
- Adult
Male
Emergency Medical Services
Adolescent
Traumatic brain injury
Poison control
610 Medicine & health
Critical Care and Intensive Care Medicine
Wounds, Nonpenetrating
Cohort Studies
03 medical and health sciences
Young Adult
0302 clinical medicine
Epidural hematoma
Outcome Assessment, Health Care
medicine
Intubation, Intratracheal
Humans
Glasgow Coma Scale
030212 general & internal medicine
Aged
Aged, 80 and over
Abbreviated Injury Scale
business.industry
030208 emergency & critical care medicine
Middle Aged
medicine.disease
United States
Anesthesia
Brain Injuries
Cohort
Intracranial pressure monitoring
Surgery
Female
business
Switzerland
Cohort study
Subjects
Details
- ISSN :
- 21630763
- Volume :
- 80
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- The journal of trauma and acute care surgery
- Accession number :
- edsair.doi.dedup.....f5e226c8111c422dfc28e69576a0f39e