Summary
Predictors of mortality in moderate hemorrhagic traumatic brain injury in the prehospital setting
Affiliation of the authors
DOI
Quote
Vázquez García MI, González Ruiz A, Pérez Sánchez JL, Rodríguez Esplandiú B, Romero Pizarro N, Corral Torres E. Predictors of mortality in moderate hemorrhagic traumatic brain injury in the prehospital setting. Rev Esp Urg Emerg. 2025;4:233–9
Summary
OBJECTIVE. To analyze the predictive value of initial vital signs and metabolic parameters obtained in the prehospital setting on mortality in moderate hemorrhagic traumatic brain injury (MHTBI).
MATERIAL AND METHODS. We conducted a retrospective analytical observational study using a prospective database. We included a cohort of adult patients with MHTBI treated by an Emergency Medical Service (EMS) over 2 years. Initial vital signs (respiratory rate, heart rate, systolic blood pressure, Glasgow Coma Scale score, and oxygen saturation) and metabolic parameters (pH, pCO2, base excess, lactate, hemoglobin [Hb], HCO3–, Na+, K+, Ca2+, Cl–, and glucose) were analyzed for their association with 7-day survival and neurological outcomes using univariable analysis (Student t or chi-square tests). Variables with statistical significance were further analyzed with binary logistic regression, receiver operating characteristic (ROC) curve analysis, optimal cutoff points, and calculation of positive and negative predictive values, sensitivity, and specificity.
RESULTS. The cohort included a total of 102 patients; mean age, 54.5 years; 69.6% were men. The 7-day survival rate was 92.2%. Statistically significant associations were found between survival and initial Hb (g/dL): 15.51 (SD, 1.69) in survivors vs 14.03 (SD, 1.20) in nonsurvivors; P = .019; AUC, 0.888 (95% CI, 0.754–1.000); final Hb: 14.68 (SD, 1.65) in survivors vs 12.54 (SD, 0.99) in nonsurvivors; P = .009; AUC, 0.850 (95% CI, 0.723–0.989); and initial K+ (mmol/L): 3.9 (SD, 0.44) in survivors vs 4.26 (SD, 0.72) in nonsurvivors, P = .04; AUC, 0.354 (95% CI, 0.020–0.680). In the binary logistic regression model, initial Hb showed an odds ratio (OR) of 1.791 (95% CI, 1.082–2.702; P = .022), final Hb showed an OR, 2.378 (95% CI, 1.091–5.180; P = .029), and initial K+: OR, 0.235 (95% CI, 0.056–0.985; P = .048).
CONCLUSIONS. Both initial and final Hb and initial K+ behaved as independent variables associated with 7-day survival. This association with early mortality in MHTBI, although requiring further validation, may provide a useful tool to aid clinical decisionmaking in EMS.