Prehospital Tx Guidelines May Improve Outcomes in Severe TBI

Survival to hospital discharge did not improve overall, but improvement seen for severe injury cohort

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FRIDAY, May 10, 2019 (HealthDay News) -- Implementation of prehospital traumatic brain injury (TBI) guidelines is associated with improvement in survival to hospital discharge for patients with severe TBI, according to a study published online May 8 in JAMA Surgery.

Daniel W. Spaite, M.D., from the University of Arizona in Phoenix, and colleagues conducted an intention-to-treat study using a before/after controlled design with patients with moderate to critically severe TBI. The correlation between implementing the nationally vetted, evidence-based prehospital treatment guidelines and outcomes was examined. A total of 21,852 patients met inclusion criteria for analysis.

The researchers found that the adjusted odds ratio (aOR) was 1.06 (95 percent confidence interval [CI], 0.93 to 1.21; P = 0.40) for survival to hospital discharge in the primary analysis. For survival to hospital admission, the aOR was 1.70 (95 percent CI, 1.38 to 2.09; P < 0.001). Guideline implementation was significantly associated with survival to discharge among the severe injury cohorts (Regional Severity Score-Head 3 to 4: aOR, 2.03 [95 percent CI, 1.52 to 2.72; P < 0.001]; Injury Severity Score 16 to 24: aOR, 1.61 [95 percent CI, 1.07 to 2.48; P = 0.02]). Among the severe, intubated subgroups, guideline implementation was also associated with significantly improved survival to discharge.

"We found a therapeutic sweet spot and showed that the guidelines had an enormous impact on people with severe TBI," Spaite said in a statement. "The guidelines did not make a difference in the moderate TBI group because those individuals would most likely have survived anyway and, unfortunately, the extent of injuries sustained in many critical patients was too extreme to overcome."

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