Abstract 15: The Accuracy of Prehospital Provider Oxygen Saturation and End-Tidal C02 Documentation in Severe Traumatic Brain Injury
Background: The prevention of secondary brain injury by EMS providers is critically important to traumatic brain injury (TBI) outcome. Mortality increases 2-6 fold with hyperventilation and doubles with a single episode of hypoxia (SpO2<90%). The Brain Trauma Foundation TBI guidelines recommend frequent (q5 min) assessment and documentation of patient vital signs, including SpO2 and ETC02 (in intubated patients); however, continuous monitoring may be more reflective of the physiology. We aimed to compare the accuracy of EMT documentation compared with continuous SpO2 and ETCO2 recording by the monitor.
Methods: Patient care reports (PCRs) and monitor (ZOLL E Series) files were collected during the treatment of TBI patients by 2 EMS agencies participating in the EPIC-TBI (Excellence in Prehospital Care-Traumatic Brain Injury) study in Arizona between 10/12-5/13. Inclusion criteria: head trauma with potential to have caused brain injury and GCS≤12, GCS<15 with decreasing GCS or increasing confusion, multisystem trauma requiring intubation, and/or post-traumatic seizures. ETCO2 and SpO2 documented by providers were compared to actual monitor records.
Results: 34 TBI cases were included (mean age= 40±20 years, 62% male, mean initial GCS = 9±4). In 8/34 cases (24%), vital signs were documented every 5 min per guidelines. SpO2 was documented below 90% by providers in 8/33 cases (24%) although, according to the monitor, SpO2 dropped below 90% in 23/33 cases (70%). Hyperventilation (ETCO2<35mmHg) was documented by providers in 4/9 cases (57%) vs. 7/9 (78%) according to the monitor. Notably, ETCO2 was not documented for 2 patients with ETCO2<35mmHg according to the monitor.
Conclusion: Hypoxia and hypocarbia are very common during the management of severe TBI. Furthermore, the presence of these conditions is significantly under-reported with EMS documentation of visually-obtained measurements. Since identification and rapid correction of hypoxia and hyperventilation are critical to TBI outcomes, continuous monitoring may be required to optimize the care of these patients.
- © 2013 by American Heart Association, Inc.