Emergency Medical Services Traumatic Brain Injury Protocols Do Not Reflect Brain Trauma Foundation Guidelines

Prehospital care for traumatic brain injuries: A review of U.S. state emergency medical services protocols

Traumatic brain injury (TBIs) necessitates a rapid and comprehensive medical response to minimize secondary brain injury and reduce mortality. Emergency medical services (EMS) clinicians serve a critical role in the management of prehospital TBI, responding during an initial phase of care with significant impact on patient outcomes. We used versions two and three of the Brain Trauma Foundation (BTF) Prehospital Guidelines for the Management of Traumatic Brain Injury and the NASEMSO National Model Clinical Guidelines to determine key elements for a TBI prehospital protocol and included common factors across sources such as recommendations concerning patient monitoring, hypoxia, hypotension, hyperventilation, cerebral herniation, airway management, hyperosmolar therapy, and transport destination. We then conducted a cross-sectional evaluation of publicly available statewide EMS clinical protocols in the US to determine the degree of alignment with national guidelines. We calculated descriptive statistics for each factor in the state protocols. Despite adoption of some evidence-based recommendations for a standard approach to the prehospital management of patients with TBI, we found significant variability in statewide EMS treatment protocols for management of severe TBI, especially in the recommended frequency of patient reassessment and for the management of suspected herniation. Most statewide protocols provided guidance regarding oxygenation, ventilation, and blood pressure management that aligned with evidence-based guidelines. While most protocols did address management of oxygenation and ventilation, one in four protocols had no specific guidance for managing hypoxia and only 31% of protocols recommended avoiding hyperventilation. For the management of suspected cerebral herniation, over half of statewide protocols recommended hyperventilation, whereas only 31% explicitly advised against hyperventilation regardless of TBI severity. Interestingly, 94% of protocols do not mention the use of hyperosmolar therapy for TBI patients, neither recommending use or avoidance of hyperosmolar therapy. In conclusion, we found inconsistent adoption of national recommendations in available statewide protocols for prehospital TBI management. We identified significant gaps and variation in statewide protocols regarding patient monitoring and reassessment, as well as in several key areas of severe TBI management.

Effect of Early Rehabilitation Nursing on Motor Function and Living Ability of Patients with Traumatic Brain Injury Based on Orem's Self-Care Theory

Objective

To explore the effect of early rehabilitation nursing on motor function and living ability of patients with traumatic brain injury (TBI) based on Orem's self-care theory.

Methods

A total of 60 patients with TBI treated in our hospital from February 2019 to June 2021 were enrolled. The patients were randomly divided into a control group and a research group. The control group adopted the early rehabilitation nursing model, while the research group adopted the early rehabilitation nursing model based on Orem's self-nursing theory. Nursing satisfaction, Fugl-Meyer score, NIH-SS score, Barthel index, quality of life score, and compliance were in the comparison of the two groups.

Results

The nursing satisfaction of the research group was higher than that of the control group (P < 0.05). Compared with the control group, the Fugl-Meyer scores of the research group were higher at 1 month, 2 months, and 3 months after nursing (P < 0.05). After nursing, the NIH-SS score of the two groups decreased. In the comparison of the two groups, the NIH-SS score of the research group at 1 month, 2 months, and 3 months after nursing was lower (P < 0.05). After nursing, the Barthel index of the two groups increased. In the comparison of the two groups, the Barthel index of the research group was higher compared to the control group at 1 month, 2 months, and 3 months after nursing (P < 0.05). The scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower (P < 0.05). The compliance rate of the research group was higher than that of the control group (P < 0.05).

Conclusion

Patients with TBI receive early rehabilitation nursing based on Orem's self-care theory, which can effectively improve patient satisfaction and compliance and achieve the purpose of improving motor function and living ability. This nursing program is worth popularizing in the clinic.

Pre-hospital mild therapeutic hypothermia for patients with severe traumatic brain injury

BACKGROUND

We aimed to assess the effects of pre-hospital mild therapeutic hypothermia (MTH) on patients with severe traumatic brain injury (sTBI).

METHODS

Eighty-six patients with sTBI were prospectively enrolled into the pre-hospital MTH group and the late MTH group (initiated in hospital). Patients in the pre-hospital MTH group were maintained at a tympanic temperature of 33°C-35°C before admission and continued to be treated with a therapeutic hypothermia device for 4 days. Patients in the late MTH group were treated with the same MTH parameters. Intracranial pressure (ICP), complications and Glasgow Outcome Scale (GOS) scores were monitored.

RESULTS

ICP was significantly lower for patients in the pre-hospital MTH group 24, 48, and 72 h after treatment (17.38 ± 4.88 mmHg, 18.40 ± 4.50 mmHg, and 16.40 ± 4.13 mmHg, respectively) than that in the late MTH group (20.63 ± 3.00 mmHg, 21.80 ± 6.00 mmHg, and 18.81 ± 4.50 mmHg) (P < .05). The favorable prognosis (GOS scores 4-5) rate in the pre-hospital MTH group was higher tha n the late MTH group (65.1% vs. 37.2%, respectively; P < .05) without complications .

CONCLUSION

Pre-hospital MTH for patients with STBI can reduce ICP and improve neurological outcomes.