Citation

McMullan JT, Ventura A, LeBlanc DP. Prehosp. Emerg. Care 2020; ePub(ePub): ePub.

Affiliation

Department of Emergency Medicine, Medical University of South Carolina.

Copyright

(Copyright © 2020, National Association of EMS Physicians, Publisher Informa - Taylor and Francis Group)

DOI

10.1080/10903127.2020.1770388

PMID

32412355

Abstract

Implementation of traumatic brain injury guideline (TBI) recommendations for prehospital care is associated with improved outcomes, but prehospital guideline uptake is frequently delayed. Our objective was to estimate how well TBI guidelines are reflected in a national sample of prehospital TBI protocols in 2012 and 2018, 5 and 11 years after guideline publication. A purposeful sample of publicly accessible prehospital protocols were obtained in 2012, and updates of those protocols were obtained in 2018. Guideline recommendations were codified into a 23-item tool that was used to dual-abstract each prehospital protocol set. Descriptive statistics and chi-square testing were used to compare differences. Fifty-three sets of protocols representing 25 states and multiple administrative structures were identified. None of the protocols contained all twenty-three elements of the guidelines, and more than one-third (19/53, 35%) did not have a TBI-specific protocol. While some individual items appeared more frequently in 2018 than 2012, more than half of the reviewed protocols do not contain guidance on ventilation or definitions of hypoxemia, hypotension, or pupil asymmetry. Evaluation of a diverse sample of EMS protocols demonstrates a significant deficit in the adoption of TBI guidelines more than a decade after publication.

Language: en

Keywords

Guidelines; Knowledge Translation; Traumatic Brain Injury