Moderate and severe brain injury among combat casualties: Secondary insult analysis

Neil B Davids, The University of Texas School of Public Health


Background: Traumatic Brain Injury (TBI) has been a common injury for military casualties in the conflicts in Iraq and Afghanistan. A key management principle in the acute phase of a TBI is to prevent further injury. There are several potentially correctable physiologic measures that can be monitored in the prehospital environment to prevent what is described as "secondary insult" in cases of TBI. The secondary insults investigated in this study are hypotension, hypoxia, hypothermia, and hyperventilation. Methods: This study was a retrospective review of the Department of Defense Trauma Registry (DoDTR) of moderate and severe traumatic brain injury cases (Head Abbreviated Injury Score (AIS) > or = 3) from January 1, 2003 to December 31, 2013 to determine rates of secondary insult in the prehospital setting. A descriptive analysis of prehospital and emergency department arrival measurements of Pa02<90%, SPB <90, Temp <95 F or 35 C, ETCO2 or PaCO2<35 was performed. Results: 2005 patients met criteria for evaluation. Of these, 280 (13.9%) had evidence of one or more secondary insults on hospital arrival (9.5% hypotension, 10.6% hypoxia, 4.4% hypothermia and 21.8% hyperventilation). Only 27% had all 4 variables recorded on hospital arrival. Only 27.4% had any variable recorded in the prehospital setting. Conclusion: Improving prevention and detection of secondary insult in the prehospital setting could potentially lead to significant reduction in morbidity and mortality in TBI patients. Yet in the majority of cases, markers for prehospital secondary insult are not captured. The true incidence of potentially preventable secondary insult of military casualties with TBI remains unknown.

Subject Area

Medicine|Public health

Recommended Citation

Davids, Neil B, "Moderate and severe brain injury among combat casualties: Secondary insult analysis" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1566312.