• Assessment: oxygenation and blood pressure. In: Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, Jernigan S, Lerner EB, Letarte PB, Moriarty T, Pons PT, Sasser S, Scalea TM, Schleien C, Wright DW. Guidelines for prehospital management of traumatic brain injury. 2nd ed. New York (NY): Brain Trauma Foundation; 2007. p. 16-25. [25 references]

This is the current release of the guideline.

This guideline updates a previous version: Brain Trauma Foundation. Guidelines for prehospital management of traumatic brain injury. New York (NY): Brain Trauma Foundation; 2000. 81 p.

Strength of recommendations (strong or weak) and quality of evidence (Class I-III) are defined at the end of the "Major Recommendations" field.

Strength of Recommendations: Weak.

Quality of Evidence: Low, primarily from Class III studies and indirect evidence.

Adult

1. Patients with suspected severe traumatic brain injury (TBI) should be monitored in the prehospital setting for hypoxemia (<90% arterial hemoglobin oxygen saturation) or hypotension (<90 mmHg systolic blood pressure [SBP]).
2. Percentage of blood oxygen saturation should be measured continuously in the field with a pulse oximeter.
3. Systolic (SBP) and diastolic blood pressure (DBP) should be measured using the most accurate method available under the circumstances.
4. Oxygenation and blood pressure should be measured as often as possible, and should be monitored continuously if possible.

Pediatrics

1. Pediatric patients with suspected severe TBI should be monitored in the prehospital setting for hypotension. Pediatric hypotension is defined as follows:

   Age	SBP
   0 to 28 days	<60 mmHg
   1 to 12 months	<70 mmHg
   1 to 10 years	<70 + 2 X age in years
   >10 years	<90 mmHg

2. Percentage of blood oxygen saturation should be measured continuously in the field with a pulse oximeter using an appropriate pediatric sensor.
3. SBP and DBP should be measured using an appropriately-sized pediatric cuff. When a blood pressure is difficult to obtain because of the child's age or body habitus, documentation of mental status, quality of peripheral pulses, and capillary refill time can be used as surrogate measures.
4. Oxygenation and blood pressure should be measured as often as possible, and should be monitored continuously if possible.

Definitions:

Quality of Evidence

Strength of Recommendation

Strong recommendations are derived from high quality evidence that provide precise estimates of the benefits or downsides of the topic being assessed.

With weak recommendations, (1) there is lack of confidence that the benefits outweigh the downsides, (2) the benefits and downsides may be equal, and/or (3) there is uncertainty about the degree of benefits and downsides.

None provided

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

• Assessment: oxygenation and blood pressure. In: Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, Jernigan S, Lerner EB, Letarte PB, Moriarty T, Pons PT, Sasser S, Scalea TM, Schleien C, Wright DW. Guidelines for prehospital management of traumatic brain injury. 2nd ed. New York (NY): Brain Trauma Foundation; 2007. p. 16-25. [25 references]

Not applicable: The guideline was not adapted from another source.

2000 (revised 2007)

Brain Trauma Foundation - Disease Specific Society
National Highway Traffic Safety Administration - Federal Government Agency [U.S.]

Brain Trauma Foundation

National Highway Traffic Safety Administration

Not stated

Authors: Neeraj Badjatia, MD; Nancy Carney, PhD; Todd J. Crocco, MD; Mary Elizabeth Fallat, MD, FACS; Halim M. A. Hennes, MD, FAAP; Andy S. Jagoda, MD, FACEP; Sarah Jernigan, MD; E. Brooke Lerner, PhD; Peter B. Letarte, MD, FACS; Thomas Moriarty, MD; Peter T. Pons, MD, FACEP; Scott Sasser, MD; Thomas M. Scalea, MD, FACS; Charles Schleien, MD; David W. Wright, MD

Participants: John E. Campbell, MD, FACEP; Pamela Drexel, Brain Trauma Foundation; Jamshid Ghajar, MD, PhD; Lauren Post, MD; Andrew W. Stern, NREMT-P, MPA, MA

Review Committee: P. David Adelson, MD, FACS, FAAP; Arthur Cooper, MD, FACS; Thomas J. Esposito, MD, MPH, FACS; John William Jermyn, DO, FACEP; Tom Judge, CCT-P; Carsten Kock-Jensen, MD, Chair, Scandinavian Neurotrauma Committee; Jon R. Krohmer, MD, FACEP; Anthony Marmarou, PhD; Lawrence Marshall, MD; Stephan Mayer, MD; Connie A. Meyer, MICT; Robert E. O'Connor, MD, MPH, FACEP; Jeffrey P. Salomone, MD, FACS; Snorre Sollid, MD, Scandinavian Neurotrauma Committee; Andreas Unterberg, MD; Alex B. Valadka, MD, FACS; Walter Videtta, MD; Robert K. Waddell II, NAEMT; Beverly Walters, MD, FACS

Education Subcommittee: Cathy Case, EMT-P; Debra Cason, RN; John Gosford; Joseph A. Grafft; Jon R. Krohmer, MD

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Brain Trauma Foundation. Guidelines for prehospital management of traumatic brain injury. New York (NY): Brain Trauma Foundation; 2000. 81 p.

None available

None available

This NGC summary was completed by ECRI Institute on June 3, 2008.

This is a limited license granted to NGC, AHRQ and its agent only. It may not be assigned, sold, or otherwise transferred. BTF owns the copyright. For any other permission regarding the use of these guidelines, please contact the Brain Trauma Foundation.