[Significance of preclinical emergency treatment for the prognosis of patients with severe craniocerebral trauma]

Abstract

In a prospective study in 147 unconscious patients (Glasgow-Coma-Scale less than or equal to 7) we examined the relevance of preclinical care for posttraumatic prognosis-basic life support (BLS) referring to ventilation/oxygenation and circulation, as well as advanced trauma-specific treatment (ATT) referring to medication and positioning. Procedures providing oxygenation and stable cardiovascular function are found to be most important. The overall survival rate amounts to 53.7 per cent (79 of 147 patients). Whereas 56.6 per cent (77 of 136 patients) of the patients being preclinically attended by a physician, survive, the survival rate is only 18.2 per cent (2 of 11 patients) among those not medically cared for. 31.9 per cent (47 of 147 patients) receive trauma-adequate optimal prehospital care, and an additional 29.2 per cent (43 of 147 patients) obtain an acceptable treatment, whereas the remaining 38.8 per cent (57 of 147 patients) must be considered insufficiently for care. Patients with optimal preclinical care have a statistically significant higher survival rate in comparison to the whole group of patients-70.2 per cent vs. 53.7 per cent-and to those receiving a less sufficient attention-70.2 per cent vs. 46.0 per cent. Besides the severity of the cerebral trauma, the quality of the preclinical medical attention, too, has been proven to be of great importance for post-traumatic course and outcome in patients with severe head injury.