Association of prehospital optimal blood pressure and peripheral oxygen saturation with hospital outcomes in sports-related and recreation-related traumatic brain injury (SRR-TBI) in Asia.

BACKGROUND

While Emergency Medical Services (EMS) guidelines improve outcomes in severe traumatic brain injury (TBI), the effect of optimal blood pressure and oxygenation on sports-related and recreation-related TBI (SRR-TBI) is unclear. This study assessed whether EMS management of systolic blood pressure (SBP) and oxygen saturation (SpO₂) influences outcomes in SRR-TBI.

METHODS

This retrospective cohort study analysed data from patients diagnosed with TBI sustaining injuries during sports, education or leisure activities and were transported by EMS from 1 January 2016 to 31 December 2022, at Pan-Asian Trauma Outcomes Study facilities. Patients were classified as receiving optimal care (SBP>110 mm Hg and SpO₂>94%), intermediate care (either SBP<110 mm Hg or SpO₂<94%) or suboptimal care (both <thresholds). Outcomes were favourable neurological recovery (Modified Rankin Scale 0-3) and survival to discharge. Adjusted ORs with 95% CIs were calculated using multivariable logistic regression, adjusting for activity, age, sex, Charlson Comorbidity Index, mechanism and intent of injury, alcohol intake, time of injury and the Excess Mortality Ratio-adjusted Injury Severity Score.

RESULTS

Among 4629 patients, 74% were male and 18.4% were <18 years old. Injuries occurred during education (3%), sports (14.5%) and leisure (82.5%). Care was optimal in 77.7%, intermediate in 19.6% and suboptimal in 2.7%. Favourable outcomes were 96.3%, 88.7% and 76%, with mortality of 0.9%, 4.7% and 8.8%, respectively (p<0.0001). Compared with suboptimal care, adjusted odds of favourable recovery and survival were 2.76 and 3.30 for optimal care, and 1.27 and 1.01 for intermediate care.

CONCLUSION

Maintaining optimal SBP and SpO2 during EMS care is associated with better neurological outcomes and survival in patients with SRR-TBI.