Objective: To evaluate the effectiveness of prehospital medical care in head-injured patients.
Patients and methods: All head-injured patients admitted in Bicêtre hospital from 1995 to 1999 were retrospectively studied. Glasgow Coma Scale (GCS) score, mean arterial pressure (MAP) and SpO(2) measured on the field were compared to GCS, MAP and SpO(2) on arrival in the hospital. All treatments given during transport and first data recorded in the hospital were noted. Each parameter was compared to outcome at 6 months. Then, significant parameters were compared with a multivariate analysis.
Results: Three hundred and four patients were included, 80% had a GCS <or= 8 and 45% a GCS = 3. At 6 months, 43% of the patients had no or mild sequelae and 45% died. Prehospital time was 2 h 55 min +/- 1 h 40 min. During transport, 75% of hypoxemic events were corrected, but GCS and MAP decreased significantly. None of the patients with non-reactive mydriasis received any osmotherapy and all patients with non-reactive mydriasis until hospital admission died (n = 55). After multivariate analysis, parameters significantly related to outcome were, on the field, MAP (p < 0.025) and at hospital SAPS II (p < 0,001), GCS (p < 0.001), non-reactive mydriasis (p < 0.025), hyperglycemia (p < 0.025) and low haemoglobinemia (p < 0.001).
Conclusion: Respect of guidelines is important to improve medical care. Prehospital management corrected hypoxemia but not hypotension. The lack of osmotherapy after mydriasis cannot be explained and is probably an error. Patient route must be simplified to decrease time delay from field to hospital. Improvement in prehospital care may decrease mortality in head-injured patients.