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. 2020 Feb 26;17(5):1504.
doi: 10.3390/ijerph17051504.

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Francisco Martín-Rodríguez  1   2 , Raúl López-Izquierdo  3 , Alicia Mohedano-Moriano  4 , Begoña Polonio-López  4 , Clara Maestre Miquel  4 , Antonio Viñuela  4 , Carlos Durantez Fernández  4 , Jesús Gómez Correas  4 , Gonçalo Marques  5 , José Luis Martín-Conty  4
Affiliations

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

Francisco Martín-Rodríguez et al. Int J Environ Res Public Health. .

Abstract

Traumatic brain injuries are complex situations in which the emergency medical services must quickly determine the risk of deterioration using minimal diagnostic methods. The aim of this study is to analyze whether the use of early warning scores can help with decision-making in these dynamic situations by determining the patients who need the intensive care unit. A prospective, multicentric cohort study without intervention was carried out on traumatic brain injury patients aged over 18 given advanced life support and taken to the hospital. Our study included a total of 209 cases. The total number of intensive-care unit admissions was 50 cases (23.9%). Of the scores analyzed, the National Early Warning Score2 was the best result presented with an area under the curve of 0.888 (0.81-0.94; p < 0.001) and an odds ratio of 25.4 (95% confidence interval (CI):11.2-57.5). The use of early warning scores (and specifically National Early Warning Score2) can help the emergency medical services to differentiate traumatic brain injury patients with a high risk of deterioration. The emergency medical services should use the early warning scores routinely in all cases for the early detection of high-risk situations.

Keywords: critical care; early warning score; emergency medical services; medical decision-making; patient safety.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Sponsor’s role: none.

Figures

Figure 1
Figure 1
Study participants flowchart. BLS: basic life support
Figure 2
Figure 2
Diagnostic performance curves and areas under the curve: (a) Intensive care unit; (b) prehospital serious adverse events; (c) early mortality. NEWS2: National Early Warning Score 2; MEWS: Modified Early Warning Score; TEWS: Triage Early Warning Score; MREMS: Modified Rapid Emergency Medicine Score
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