Background: Severe traumatic brain injury (TBI) is a significant health concern and a major burden for society. The\r\nperiod between trauma event and hospital admission in an emergency department (ED) could be a determinant\r\nfor secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors\r\nassociated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of\r\nmortality and impaired consciousness of survivors at 14 days.\r\nMethods: A multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland.\r\nAdults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome\r\nmeasures were death and impaired consciousness (Glasgow Coma Scale (GCS) =13) at 14 days. The associations\r\nbetween risk factors and outcome were assessed with univariate and multivariate regression models.\r\nResults: 589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14),\r\nwith abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients\r\nsustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-ofhospital\r\nEmergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451\r\npatients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in\r\n73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and\r\ntrauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with\r\nimpaired consciousness; indirect admission was a protective factor.\r\nConclusion: Mortality and impaired consciousness at 14 days do not have the same prehospital risk factors;\r\nprehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired\r\nconsciousness.
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