[Audit of the prehospital management of severe head injured patients in the "Pays-de-la-Loire" region]

Abstract

Objective: To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005.

Study design: Prospective and multicenter.

Patients and methods: All patients managed by Samu with GCS</=8 on the field, starting from a GCS</=10.

Results: We report on 125 patients (88% of all SHIP managed in 2005), including 114 with a GCS less or equal to eight on which analysis was performed: age: 37+/-20 years, men: 4/1, road accident: 73%, fall: 20%, (polytrauma: 53%, artificial ventilation: 92%). Delays: field medical care 54+/-28 min, transportation: 32+/-29 min, total time to hospital: 1 h 55+/-48 min. Direct admission in a center with neurosurgery on site: 68%; 47% of patients admitted in general hospitals were transferred to a tertiary hospital (71% to neurosurgery). Mortality before 24th hour (23%) was associated (p<0.05) with shorter transfer time, older patient, persistent shock, fluid loading greater than 1500 ml, continuous infusion of vasopressors, focal neurological deficit. Problems were reported by Samu teams (21% of cases): medical care (32%), emergency ambulance availability (20%), alerting process (16%), on field care before Samu (12%). Of note, mannitol was never used, despite a mydriasis.

Conclusion: We observed a delayed referral of patients to a tertiary hospital, a limited use of CT image transmission and the absence of mannitol administration but also organisational problems reported in 21% of cases problems are main target for quality improvement.