Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury
Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome i...
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| Veröffentlicht in: | Journal of clinical medicine 2024-04, Vol.13 (8), p.2249 |
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| creator | Bulte, Carolien S E Mansvelder, Floor J Loer, Stephan A Bloemers, Frank W Den Hartog, Dennis Van Lieshout, Esther M M Hoogerwerf, Nico van der Naalt, Joukje Absalom, Anthony R Peerdeman, Saskia M Giannakopoulos, Georgios F Schwarte, Lothar A Schober, Patrick Bossers, Sebastiaan M |
| description | Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality.
A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury.
A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91,
= 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16,
= 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76,
= 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale.
In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime. |
| doi_str_mv | 10.3390/jcm13082249 |
| format | Article |
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A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury.
A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91,
= 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16,
= 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76,
= 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale.
In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm13082249</identifier><identifier>PMID: 38673522</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Brain ; Cardiopulmonary resuscitation ; Comparative analysis ; CPR ; Day ; Emergency medical care ; Emergency medical services ; Emergency services ; Health aspects ; Hospitals ; Injuries ; Intubation ; Medical appointments and schedules ; Medical research ; Medicine, Experimental ; Mortality ; Netherlands ; Night ; Patients ; Regression analysis ; Trauma ; Traumatic brain injury ; United Kingdom</subject><ispartof>Journal of clinical medicine, 2024-04, Vol.13 (8), p.2249</ispartof><rights>COPYRIGHT 2024 MDPI AG</rights><rights>2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c379t-345a5d90454906d2b2f931555fcb8d48d0c09718b30eac73542e83e11cbce4c33</cites><orcidid>0000-0002-8393-4946 ; 0000-0001-9873-2418 ; 0000-0001-6119-7810 ; 0000-0003-1926-8018 ; 0000-0002-6375-8359 ; 0000-0002-4531-6098 ; 0000-0001-5691-3210 ; 0000-0003-0814-081X ; 0000-0003-1815-6989</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38673522$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bulte, Carolien S E</creatorcontrib><creatorcontrib>Mansvelder, Floor J</creatorcontrib><creatorcontrib>Loer, Stephan A</creatorcontrib><creatorcontrib>Bloemers, Frank W</creatorcontrib><creatorcontrib>Den Hartog, Dennis</creatorcontrib><creatorcontrib>Van Lieshout, Esther M M</creatorcontrib><creatorcontrib>Hoogerwerf, Nico</creatorcontrib><creatorcontrib>van der Naalt, Joukje</creatorcontrib><creatorcontrib>Absalom, Anthony R</creatorcontrib><creatorcontrib>Peerdeman, Saskia M</creatorcontrib><creatorcontrib>Giannakopoulos, Georgios F</creatorcontrib><creatorcontrib>Schwarte, Lothar A</creatorcontrib><creatorcontrib>Schober, Patrick</creatorcontrib><creatorcontrib>Bossers, Sebastiaan M</creatorcontrib><creatorcontrib>BRAIN-PROTECT Collaborators</creatorcontrib><title>Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality.
A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury.
A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91,
= 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16,
= 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76,
= 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale.
In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.</description><subject>Brain</subject><subject>Cardiopulmonary resuscitation</subject><subject>Comparative analysis</subject><subject>CPR</subject><subject>Day</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency services</subject><subject>Health aspects</subject><subject>Hospitals</subject><subject>Injuries</subject><subject>Intubation</subject><subject>Medical appointments and schedules</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Mortality</subject><subject>Netherlands</subject><subject>Night</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Trauma</subject><subject>Traumatic brain injury</subject><subject>United Kingdom</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkd1LHDEUxYNYqlif-i6BvghlbT43yaPd2lYQFdTnIZO5WbPMTLZJprD_fbPV-lG8ebiXy-8cbjgIfaTkhHNDvqzcQDnRjAmzg_YZUWpGuOa7L-Y9dJjzitTSWjCq3qM9rueKS8b20fLMe3AFR4-_2U0JA-DfkPKU8WVY3pe_izji6wT3Ma9DsT1e2ATYjh2-moqLA2RsfYGEb6AqAd8mOw22BIe_JhtGfD6uprT5gN5522c4fOwH6O772e3i5-zi6sf54vRi5rgyZcaFtLIzREhhyLxjLfOGUymld63uhO6II0ZR3XIC1tU_CAaaA6WudSAc5wfo-MF3neKvCXJphpAd9L0dIU654UQoI4wypKKf_kNXcUpjvW5LzQ2dG82eqaXtoQmjjyVZtzVtTpXhUlY3WamTN6j6OhiCiyP4UPevBJ8fBC7FnBP4Zp3CYNOmoaTZJtu8SLbSR4-nTu0A3RP7L0f-B1wsm44</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Bulte, Carolien S E</creator><creator>Mansvelder, Floor J</creator><creator>Loer, Stephan A</creator><creator>Bloemers, Frank W</creator><creator>Den Hartog, Dennis</creator><creator>Van Lieshout, Esther M M</creator><creator>Hoogerwerf, Nico</creator><creator>van der Naalt, Joukje</creator><creator>Absalom, Anthony R</creator><creator>Peerdeman, Saskia M</creator><creator>Giannakopoulos, Georgios F</creator><creator>Schwarte, Lothar A</creator><creator>Schober, Patrick</creator><creator>Bossers, Sebastiaan M</creator><general>MDPI AG</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8393-4946</orcidid><orcidid>https://orcid.org/0000-0001-9873-2418</orcidid><orcidid>https://orcid.org/0000-0001-6119-7810</orcidid><orcidid>https://orcid.org/0000-0003-1926-8018</orcidid><orcidid>https://orcid.org/0000-0002-6375-8359</orcidid><orcidid>https://orcid.org/0000-0002-4531-6098</orcidid><orcidid>https://orcid.org/0000-0001-5691-3210</orcidid><orcidid>https://orcid.org/0000-0003-0814-081X</orcidid><orcidid>https://orcid.org/0000-0003-1815-6989</orcidid></search><sort><creationdate>20240401</creationdate><title>Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury</title><author>Bulte, Carolien S E ; 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In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality.
A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury.
A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91,
= 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16,
= 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76,
= 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale.
In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>38673522</pmid><doi>10.3390/jcm13082249</doi><orcidid>https://orcid.org/0000-0002-8393-4946</orcidid><orcidid>https://orcid.org/0000-0001-9873-2418</orcidid><orcidid>https://orcid.org/0000-0001-6119-7810</orcidid><orcidid>https://orcid.org/0000-0003-1926-8018</orcidid><orcidid>https://orcid.org/0000-0002-6375-8359</orcidid><orcidid>https://orcid.org/0000-0002-4531-6098</orcidid><orcidid>https://orcid.org/0000-0001-5691-3210</orcidid><orcidid>https://orcid.org/0000-0003-0814-081X</orcidid><orcidid>https://orcid.org/0000-0003-1815-6989</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MDPI - Multidisciplinary Digital Publishing Institute; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Brain Cardiopulmonary resuscitation Comparative analysis CPR Day Emergency medical care Emergency medical services Emergency services Health aspects Hospitals Injuries Intubation Medical appointments and schedules Medical research Medicine, Experimental Mortality Netherlands Night Patients Regression analysis Trauma Traumatic brain injury United Kingdom |
| title | Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury |
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