The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only

Emergency Medicine Journal : EMJ
A GarnerVal Gebski

Abstract

Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score <9 (original definition), or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 (modified definition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), p<0.01, Number needed to treat =...Continue Reading

Associated Clinical Trials

Jun 3, 2005·Alan Garner

References

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Citations

Jan 8, 2016·Lancet·Mark H WilsonChirstopher H E Imray
Apr 19, 2015·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Alan A GarnerVal Gebski
Oct 21, 2016·Resuscitation·Johannes von Vopelius-Feldt, Jonathan R Benger
Jun 8, 2017·The Journal of Trauma and Acute Care Surgery·Stephanie Laura Wilson, Vinay Gangathimmaiah
Jan 24, 2019·Medical Sciences : Open Access Journal·Iris PélieuBernhard Walder
Jan 30, 2019·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Zar PopalGeorgios F Giannakopoulos
May 8, 2019·Journal of Neurotrauma·Sophie RichterVirginia F J Newcombe
May 8, 2019·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Cino BendinelliZsolt Janos Balogh
Jul 25, 2019·The Journal of Trauma and Acute Care Surgery·Jürgen KnappMichael Bernhard
Jan 18, 2020·Acta Anaesthesiologica Scandinavica·Bjarke RisgaardLars S Rasmussen
Jan 23, 2016·Journal of Neurosurgical Anesthesiology·Michael HoffmannUNKNOWN TraumaRegister DGU of the German Trauma Society (DGU)
Jan 22, 2020·Emergency Medicine Journal : EMJ·Alistair MaddockStephen Hearns
Jul 19, 2017·PLoS Medicine·David J Lockey
Nov 16, 2019·Emergency Medicine Australasia : EMA·Jemma C KingPeter A Leggat
Jan 30, 2019·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Toni PakkanenTom Silfvast
Jan 12, 2019·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Pedram EmamiUNKNOWN TraumaRegister DGU® of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; DGU)
May 19, 2021·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Matilda K BjörklundKatie Gillies

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Methods Mentioned

BETA
sedation

Clinical Trials Mentioned

NCT00112398

Related Concepts

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.