A multicenter cohort study found that prehospital hypoxia, hypotension, and hypocarbia may increase the risks of mortality and disability in patients with traumatic brain injury.

In the study, published in JAMA Network Open, investigators analyzed data from 14,994 adult patients (median age = 47 years, 71% male) treated at eight level I trauma centers within the Linking Investigations in Trauma and Emergency Services (LITES) Network from 2017 to 2021. Death occurred in 2% of patients in the emergency department (ED), 12% of deaths occurred during hospitalization, and 25% had an unfavorable discharge disposition.

The study's detailed outcomes showed that hypoxia was associated with an increased risk of ED death (ARR, 2.24; 95% CI, 1.69-2.97) and hospital death (adjusted relative risk [RR] = 1.33, 95% confidence interval [CI] = 1.23–1.44). Hypotension correlated with higher risks of ED death (adjusted RR = 2.05, 95% CI = 1.54–2.72) and hospital death (adjusted RR = 1.18, 95% CI = 1.10–1.28). Hypocarbia presented the highest risk for ED death, with an adjusted RR of 7.99 (95% CI = 2.47–25.85).

"Prehospital hypoxia, hypotension, and hypocarbia were associated with poorer TBI outcomes. These results underscore the importance of optimal oxygenation, ventilation, and perfusion in prehospital TBI care," said lead study author Amelia W. Maiga, MD, MPH, of the Division of Acute Care Surgery in the Department of Surgery in the Section of Surgical Sciences at the Vanderbilt University Medical Center, and her colleagues.

The findings further highlighted the need to adhere to Brain Trauma Foundation (BTF) guidelines during prehospital care, as preventing these physiologic events could significantly improve survival and functional outcomes after TBI.

Strengths of the study included its large, diverse multicenter cohort and robust data linkage. However, limitations involved its observational design, potential selection bias, and the absence of long-term outcome data.

No additional conflicts of interest were disclosed.