Clinical assessment of risk factors in traumatic brain injury
Introduction
Traumatic brain injury remains a leading global health concern with significant social and economic impact. The main causes include traffic accidents, falls, and violence, especially affecting young adults. In the Republic of Moldova, TBI incidence is rising, particularly during the prehospital phase. TBI involves both primary and secondary brain injuries, the latter often resulting from hypoxia, hypotension, or hyperglycemia. These secondary insults critically influence outcomes and are associated with high mortality. Effective prehospital management – focused on stabilizing oxygenation and hemodynamics – is essential in reducing neurological deterioration. Emergency teams play a key role in preventing secondary injury and improving survival.
Materials and methods
This study, conducted from 2020 to 2024, analyzed 486 patients with acute traumatic brain injury (TBI) assessed in both prehospital and emergency department settings. It aimed to evaluate injury severity and prognosis using clinical tools and structured observation forms, developed specifically for this research.
Results
Significant correlations were found between increased age, low systolic blood pressure, prehospital hypoxia, and both TBI severity and mortality (p < 0.0001). While hyperglycemia was not significantly associated with injury severity, it showed a moderate negative correlation with mortality (p < 0.01). Findings emphasize the importance of early monitoring and stabilization of vital signs in the prehospital phase to improve TBI outcomes.
Conclusions
This study emphasizes the importance of systematic prehospital monitoring and management of physiological parameters to mitigate secondary brain injury and improve patient prognosis. Early intervention targeting hypoxia and hypotension remains vital in the acute management of TBI.
Emergency care for trauma patients in the red zone: clinical experience from 2024
Introduction
The traumatized patient with signs of shock remains a major cause of morbidity and mortality, requiring rapid diagnosis and multidisciplinary management. This study evaluates clinical, paraclinical, and therapeutic aspects of trauma patients admitted with shock signs in the red zone of the Emergency Department of the Institute of Emergency Medicine during 2024.
Material and methods
A prospective analysis of 60 polytrauma patients in shock was performed. Demographic data, trauma mechanisms, Glasgow Coma Score, vital signs, imaging, emergency interventions, and outcomes were evaluated. The patients were managed according to an experimental protocol developed at the institutional level, which provides for a multidisciplinary approach to the traumatized patient. This protocol was developed based on the international protocol for Advanced Trauma Life Support. It will later be implemented at the institutional level.
Results
The cohort included 79% males, with a mean age of 49.7 ± 15.2 years; 75% urban residents. Grade III and IV shock were diagnosed in 40% and 28.3%, respectively. Causes of trauma included physical aggression (29.5%), road traffic accidents (28.5%), and accidental trauma (21.0%), falls from height (21.0%). Radiological lesions were detected in 63.3%, positive findings on Focused Assessment with Sonography for Trauma in 40%, and cranial lesions identified by computed tomography in 60%. Intraglotic intubation was required in 80% of patients, vasopressor support was administered in 50%, antibiotic therapy in 95%, and emergency surgery was performed in 30%. Mortality was 1.7%.
Conclusions
Protocol-driven multidisciplinary care facilitated effective stabilization of traumatized patients presenting with shock. Early diagnosis, the use of advanced imaging techniques, and timely therapeutic interventions significantly contributed to improved patient outcomes. These findings underscore the critical role of structured trauma life support protocols in emergency medical settings.