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, Raúl López-Izquierdo, Alicia Mohedano-Moriano, Begoña Polonio-López, Clara Maestre Miquel, Antonio Viñuela, Carlos Durantez Fernández, Jesús Gómez Correas, Gonçalo Marques and José Luis Martín-Conty
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Francisco Martín-Rodríguez: Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain
Raúl López-Izquierdo: Emergency department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain
Alicia Mohedano-Moriano: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
Begoña Polonio-López: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
Clara Maestre Miquel: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
Antonio Viñuela: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
Carlos Durantez Fernández: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
Jesús Gómez Correas: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
Gonçalo Marques: Instituto de Telecomunicaciones, Universidad de Beira Interior, 6200-001 Covilhã, Portugal
José Luis Martín-Conty: Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain

IJERPH, 2020, vol. 17, issue 5, 1-14

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: early warning score; emergency medical services; patient safety; medical decision-making; critical care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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