Pre-hospital anaesthesia and assessment of head injured patients presenting to a UK Helicopter Emergency Medical Service with a high Glasgow Coma Scale: a cohort study
Bootland, Duncan Rose, Caroline Barrett, Jack
Lyon, Richard M. Kent, Surrey and Sussex Air Ambulance Trust
Bootland, Duncan
Rose, Caroline
Lyon, Richard M.
Kent, Surrey and Sussex Air Ambulance Trust
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Abstract
Objectives Patients who sustain a head injury but
maintain a Glasgow Coma Scale (GCS) of 13–15 may
still be suffering from a significant brain injury. We aimed
to assess the appropriateness of triage and decision to
perform prehospital rapid sequence induction (RSI) in
patients attended by a UK Helicopter Emergency Medical
Service (HEMS) following head injury.
Design A retrospective cohort study of patients attended by
Kent Surrey & Sussex Air Ambulance Trust (KSSAAT) HEMS.
Setting A mixed urban and rural area of 4.5million people
in South East England.
Participants GCS score of 13, 14 or 15 on arrival of the
HEMS team and clinical findings suggesting head injury.
Patients accompanied by the HEMS team to hospital
(‘Escorted’), and those that were ‘Assisted’ but conveyed
by the ambulance service were reviewed. No age
restrictions to inclusion were set.
Primary outcome measure Significant brain injury.
Secondary outcome measure Recognition of patients
requiring prehospital anaesthesia for head injury.
Results Of 517 patients, 321 had adequate follow-up,
69% of these were Escorted, 31% Assisted. There was
evidence of intracranial injury in 13.7% of patients and
clinically important brain injury in 7.8%. There was no
difference in the rate of clinically important brain injury
between Escorted and Assisted patients (p=0.46).
Nineteen patients required an RSI by the HEMS team and
this patient group was significantly more likely to have
clinically important brain injury (p=0.04).
Conclusion In patients attended by a UK HEMS service
with a head injury and a GCS of 13–15, a small but
significant proportion had a clinically important brain
injury and a proportion were appropriately recognised
as requiring prehospital RSI. For patients deemed not to
need a HEMS intervention, differentiating between those
with and without clinically important brain injury appears
challenging.
https://bmjopen.bmj.com/content/9/2/e023307.long
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2018-023307