Emergency treatment guidelines improve the survival of people with severe head trauma

Press release

Wednesday, May 8, 2019

An NIH-funded study shows that the protocol can help people with severe traumatic brain injury.

A large study of more than 21,000 people found that training emergency medical services agencies to implement prehospital guidelines for traumatic brain injury could help improve the survival of patients with traumatic brain injury. serious. The findings were published in JAMA Surgery, and the study was funded by the National Institute of Neurological Disorders and Stroke (NINDS), which is part of the National Institutes of Health.

"This shows the importance of conducting real-world studies and provides a solid database of guidelines," said Patrick Bellgowan, Ph.D., program director at NINDS. "This suggests that we can systematically increase the chances of saving the lives of thousands of people with serious traumatic brain injuries."

Based on numerous observational studies, the guidelines for the pre-hospital management of TBI, developed in 2000 and updated in 2007, focus on the prevention of oxygen deficiency, blood pressure and hyperventilation people with head trauma. Overall, studies have suggested that controlling these factors before patients arrive in the hospital could improve survival, but that actual adherence to the guidelines was not examined.

The EPIC (Excellence in Prehospital Injury Care) study, led by Daniel Spaite, professor of emergency medicine at the University of Arizona at Tucson, trained Arizona EMS agencies on TBI guidelines and compared the results for patients before and after the implementation of the recommendations. All patients in the study suffered a head injury with loss of consciousness. This public health initiative was a collaboration between the University and the Department of Health Services of Arizona. The EPIC study is the first time that guidelines have been evaluated under real-world conditions.

The results showed that the implementation of the guidelines did not affect the overall survival of the entire group, including patients with moderate, severe and critical lesions. However, further analysis revealed that the guidelines doubled the survival rate of people with severe brain trauma and three times the survival rate of patients with severe brain trauma to which a breathing tube was to be inserted by the medical staff. The guidelines were also associated with an overall increase in survival at hospitalization.

"We found a good therapeutic point and showed that the recommendations had a huge impact on people with serious BITs. The guidelines made no difference in the moderate TBI group, as these people would most likely have survived anyway and, unfortunately, the magnitude of the injuries suffered by many critical patients was too extreme to overcome, "he said. Dr. Spaite.

Bentley Bobrow, MD, professor of emergency medicine at the University of Arizona and co-principal investigator of the study, said: "It was exciting to see such dramatic results result from A simple two hour training session with the medical services staff.

Although the guidelines provide specific recommendations on oxygen levels and blood pressure, researchers will consider whether to revise these ranges. Further research is needed to determine the best airway management and respiratory support strategies to optimize ventilation. Further studies will focus on the best methods for national and global adoption of the BITs.

This work was supported by the NINDS (NS071049).

NINDS is the largest funder of brain and nervous system research. NINDS 'mission is to research fundamental knowledge about the brain and the nervous system and to use it to reduce the burden of neurological diseases.

About the National Institutes of Health (NIH):
The NIH, the country's medical research agency, has 27 institutes and centers and is part of the US Department of Health and Human Services. NIH is the lead federal agency that leads and supports basic, clinical and translational medical research. She studies causes, treatments and cures for common and rare diseases. For more information on NIH and its programs, visit www.nih.gov.

NIH … transforming discovery into health^®

###