Pélieu Iris, Kull Corey, Walder Bernhard
Division of Anaesthesiology, University Hospitals of Geneva, 12011 Geneva, Switzerland.
Med Sci (Basel). 2019 Jan 21;7(1):12. doi: 10.3390/medsci7010012.
Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out based on limited clinical diagnostics. Potential new mobile diagnostics may decrease these errors. Prehospital care includes decision-making in clinical pathways, means of transport, and the degree of prehospital treatment. Emergency care at hospital admission includes the definitive diagnosis of TBI with, or without extracranial lesions, and triage to the appropriate receiving structure for definitive care. Early risk factors for an unfavorable outcome includes the severity of TBI, pupil reaction and age. These three variables are core variables, included in most predictive models for TBI, to predict short-term mortality. Additional early risk factors of mortality after severe TBI are hypotension and hypothermia. The extent and duration of these two risk factors may be decreased with optimal prehospital and emergency care. Potential new avenues of treatment are the early use of drugs with the capacity to decrease bleeding, and brain edema after TBI. There are still many uncertainties in prehospital and emergency care for TBI patients related to the complexity of TBI patterns.
创伤性脑损伤（TBI）是一个重大的医疗保健问题，也是社会的一大负担。在院前环境中，识别TBI可能具有挑战性，尤其是在未被观察到跌倒的老年患者中。基于有限的临床诊断，不能排除现场分诊错误的可能性。潜在的新型移动诊断方法可能会减少这些错误。院前护理包括临床路径中的决策、运输方式和院前治疗程度。入院时的急诊护理包括对有无颅外损伤的TBI进行明确诊断，并分诊至适当的接收机构进行确定性治疗。不良预后的早期危险因素包括TBI的严重程度、瞳孔反应和年龄。这三个变量是核心变量，包含在大多数TBI预测模型中，用于预测短期死亡率。重度TBI后死亡的其他早期危险因素是低血压和体温过低。通过优化院前和急诊护理，这两个危险因素的程度和持续时间可能会降低。潜在的新治疗途径是早期使用具有减少TBI后出血和脑水肿能力的药物。由于TBI模式的复杂性，TBI患者的院前和急诊护理仍存在许多不确定性。
