Introduction and purpose
The controversy between the “scoop and run” versus the “stay and play” approach in severely injured trauma patients has been an ongoing issue for decades. The present study was undertaken to investigate whether changes in prehospital care for patients with severe traumatic brain injury in the Netherlands have improved outcome.
In this retrospective study, files (n = 60) were analyzed from a prospectively collected database including all patients admitted to one of six hospitals in the Limburg region in the Netherlands with a Glasgow Coma Scale (GCS) score ≤8 on admittance over the period from January 2006 to December 2008. All patients had traumatic brain damage proven on computed tomography (CT) or magnetic resonance imaging (MRI). Relevant prehospital and clinical data from the present cohort were compared to data from a similar study (n = 30) conducted 20 years ago. The primary outcome assessed was mortality.
The two study groups had similar characteristics with regard to the GCS score. In the historic cohort, Basic Life Support (BLS) and the “scoop and run” approach in patients with major traumatic brain injury was common, with an average time on scene of 7.5 min. Currently, prehospital care is performed mainly on the level of prehospital Advanced Life Support (ALS), with the average time on scene being about four times as long as in the historic cohort. However, the overall mortality rate for the current cohort compared to the historic cohort has not changed.
Despite more on-site ALS in severely head injured patients nowadays compared to the historic cohort, there was no reduction in mortality.
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Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(8):728–41.
Finfer SR, Cohen J. Severe traumatic brain injury. Resuscitation. 2001;48:77–90.
Martins ET, Linhares MN, Sousa DS, Schroeder HK, Meinerz J, Rigo LA, Bertotti MM, Gullo J, Hohl A, Dal-Pizzol F, Walz R. Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis city. J Trauma. 2009;67:85–90.
Hukkelhoven CW, Steyerberg EW, Farace E, Habbema JD, Marshall LF, Maas AI. Regional differences in patient characteristics, case management, and outcomes in traumatic brain injury: experience from the tirilazad trials. J Neurosurg. 2002;97:549–57.
Harris OA, Bruce CA, Reid M, Cheeks R, Easley K, Surles MC, Pan Y, Rhoden-Salmon D, Webster D, Crandon I. Examination of the management of traumatic brain injury in the developing and developed world: focus on resource utilization, protocols, and practices that alter outcome. J Neurosurg. 2008;109:433–8.
Ghajar J. Traumatic brain injury. Lancet. 2000;356(9233):923–9.
Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, Schouten J, Shutter L, Timmons SD, Ullman JS, Videtta W, Wilberger JE, Wright DW. Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma. 2007;24(Suppl 1):S7–13.
Jones PA, Andrews PJ, Midgley S, Anderson SI, Piper IR, Tocher JL, Housley AM, Corrie JA, Slattery J, Dearden NM, Miller JD. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol. 1994;6:4–14.
Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg. 1991;75:S59–66.
Anderson V, Brown S, Newitt H, Hoile H. Educational, vocational, psychosocial, and quality-of-life outcomes for adult survivors of childhood traumatic brain injury. J Head Trauma Rehabil. 2009;24:303–12.
Myburgh JA, Cooper DJ, Finfer SR, Venkatesh B, Jones D, Higgins A, Bishop N, Higlett T; Australasian Traumatic Brain Injury Study (ATBIS) Investigators for the Australian; New Zealand Intensive Care Society Clinical Trials Group. Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma. 2008;64:854–62.
Hesdorffer DC, Rauch SL, Tamminga CA. Long-term psychiatric outcomes following traumatic brain injury: a review of the literature. J Head Trauma Rehab. 2009;24:452–9.
von Steinbüchel N, Wilson L, Gibbons H, Hawthorne G, Höfer S, Schmidt S, Bullinger M, Maas A, Neugebauer E, Powell J, von Wild K, Zitnay G, Bakx W, Christensen AL, Koskinen S, Formisano R, Saarajuri J, Sasse N, Truelle JL; QOLIBRI Task Force. Quality of Life after Brain Injury (QOLIBRI): scale validity and correlates of quality of life. J Neurotrauma. 2010;27:1157–65.
Haas B, Nathens AB. Pro/con debate: is the scoop and run approach the best approach to trauma services organization? Crit Care. 2008;12:224.
Liberman M, Mulder D, Lavoie A, Denis R, Sampalis JS. Multicenter Canadian study of prehospital trauma care. Ann Surg. 2003;237:153–60.
Härtl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma. 2006;60(6):1250–6.
Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg. 1993;7:267–79.
Khan F, Baguley IJ, Cameron ID. 4: Rehabilitation after traumatic brain injury. Med J Aust. 2003;178:290–5.
Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34:216–22.
Hunt J, Hill D, Besser M, West R, Roncal S. Outcome of patients with neurotrauma: the effect of a regionalized trauma system. Aust N Z J Surg. 1995;65:83–6.
Cooper DJ, Myles PS, McDermott FT, Murray LJ, Laidlaw J, Cooper G, Tremayne AB, Bernard SS, Ponsford J; HTS Study Investigators. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291:1350–7.
Smith RM, Conn AK. Prehospital care—scoop and run or stay and play? Injury. 2009;40:S23–6.
Draaisma JMT. Evaluation of trauma care—with an emphasis on prehospital care. Thesis, Nijmegen University, 1987.
Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R, Deitch EA, Livingston DH. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52:907–11.
Stichting Landelijke Ambulance & Meldkamer Protocollen (LAMP), National Protocol Ambulance Care (Landelijk Protocol Ambulancezorg). 2006, Version 7.0.
Chapleau W. ALS vs BLS. Emerg Med Serv. 2002;31:102–3.
van der Velden MW, Ringburg AN, Bergs EA, Steyerberg EW, Patka P, Schipper IB. Prehospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care. Emerg Med J. 2008;25:444–9.
Jacobs LM, Sinclair A, Beiser A, D’Agostino RB. Prehospital advanced life support: benefits in trauma. J Trauma. 1984;24:8–13.
Potter D, Goldstein G, Fung SC, Selig M. A controlled trial of prehospital advanced life support in trauma. Ann Emerg Med. 1988;17:582–5.
Liberman M, Mulder D, Sampalis J. Advanced or basic life support for trauma: meta-analysis and critical review of the literature. J Trauma. 2000;49(4):584–99.
Bullock RM, Chesnut RM, Clifton GL, Ghajar J, Marion DW, Narayan RK, Newell DW, Pitts LW, Rosner MJ, Walter BC, Wilberger JE. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2000;17:449–553.
Lu J, Marmarou A, Choi S, Maas A, Murray G, Steyerberg EW; Impact and Abic Study Group. Mortality from traumatic brain injury. Acta Neurochir Suppl. 2005;95:281–5.
Mullins RJ, Veum-Stone J, Hedges JR, Zimmer-Gembeck MJ, Mann NC, Southard PA, Helfand M, Gaines JA, Trunkey DD. Influence of a statewide trauma system on location of hospitalization and outcome of injured patients. J Trauma. 1996;40:536–45.
Sampalis JS, Lavoie A, Boukas S, Tamim H, Nikolis A, Fréchette P, Brown R, Fleiszer D, Denis R, Bergeron E, Mulder D. Trauma center designation: initial impact on trauma-related mortality. J Trauma. 1995;39:232–7.
Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370–8.
Wang HE, Peitzman AB, Cassidy LD, Adelson PD, Yealy DM. Out-of-hospital endotracheal intubation and outcome after traumatic brain injury. Ann Emerg Med. 2004;44:439–50.
Murray JA, Demetriades D, Berne TV, Stratton SJ, Cryer HG, Bongard F, Fleming A, Gaspard D. Prehospital intubation in patients with severe head injury. J Trauma. 2000;49(6):1065–70.
Davis DP, Peay J, Sise MJ, Vilke GM, Kennedy F, Eastman AB, Velky T, Hoyt DB. The impact of prehospital endotracheal intubation on outcome in moderate to severe traumatic brain injury. J Trauma. 2005;58(5):933–9.
Denninghoff KR, Griffin MJ, Bartolucci AA, LoBello SG, Fine PR. Emergent endotracheal intubation and mortality in traumatic brain injury. West J Emerg Med. 2008;9:184–9.
DiRusso SM, Sullivan T, Risucci D, Nealon P, Slim M. Intubation of pediatric trauma patients in the field: predictor of negative outcome despite risk stratification. J Trauma. 2005;59:84–90.
Winchell RJ, Hoyt DB. Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego. Arch Surg. 1997;132:592–7.
de Knegt C, Meylaerts SAG, Leenen LPH. Applicability of the trimodal distribution of trauma deaths in a Level I trauma centre in the Netherlands with a population of mainly blunt trauma. Injury. 2008;39(9):993–1000.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
Pfeifer R, Tarkin IS, Rocos B, Pape H-C. Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury. 2009;40:907–11.
Deuning CM. Distance (in kilometers) to the nearest hospital 2008 [Afstand (in kilometers) tot dichtstbijzijnde ziekenhuis 2008]. RIVM, Bilthoven, Netherlands. http://www.zorgatlas.nl/zorg/ziekenhuiszorg/algemene-en-academische-ziekenhuizen/aanbod/afstand-tot-dichtstbijzijnde-ziekenhuis (2011). Accessed 11 Jan 2012.
Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, Field B, Luinstra-Toohey L, Maloney J, Dreyer J, Lyver M, Campeau T, Wells GA; OPALS Study Group. The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ. 2008;178(9):1141–52.
Conflict of interest
The authors did not receive any outside funding or grants in support of their research for the preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed or agreed to pay or direct any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors or a member of their immediate families are affiliated or associated.
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Aubuchon, M.M.F., Hemmes, B., Poeze, M. et al. Prehospital care in patients with severe traumatic brain injury: does the level of prehospital care influence mortality?. Eur J Trauma Emerg Surg 39, 35–41 (2013). https://doi.org/10.1007/s00068-012-0218-6
- Traumatic brain injury
- Prehospital care
- Advanced Life Support
- Basic Life Support