Mesh ： Adolescent Adult Arizona / epidemiology Brain Injuries / complications mortality therapy Child Child, Preschool Clinical Protocols / standards Emergency Medical Services / methods organization & administration standards Female Humans Hyperventilation / diagnosis etiology therapy Hypoventilation / diagnosis etiology therapy Infant Infant, Newborn Male Organizational Case Studies Outcome and Process Assessment, Health Care Oxygen Consumption Positive-Pressure Respiration / adverse effects standards Practice Guidelines as Topic Prospective Studies Time-to-Treatment / standards Trauma Severity Indices Young Adult

来  源：   DOI：10.1111/acem.12411   PDF(Sci-hub)   PDF(Pubmed)

Abstract：
Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence-based prehospital and in-hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines-the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, \"EPIC\"; and 3R01NS071049-S1, \"EPIC4Kids\"). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled.
摘要：
创伤性脑损伤（TBI）对社会造成了巨大的损失。幸运的是,越来越多的证据表明,在伤后早期治疗TBI可以显著降低发病率和死亡率.作为回应,权威机构已经制定了基于证据的院前和院内TBI治疗指南.然而,尚无大型研究评估在院前环境中实施这些指南的有效性.本文介绍了研究背景,设计,实施，紧急医疗服务（EMS）治疗方案，和前瞻性的统计分析，控制（之前/之后），全州研究旨在评估实施EMSTBI指南的效果-院前伤害护理卓越（EPIC）研究（NIH/NINDSR01NS071049，“EPIC”；和3R01NS071049-S1，“EPIC4Kids”）。该研究的具体目的是检验以下假设：在全州范围内实施国际成人和儿童EMSTBI指南将显着降低中度或重度TBI患者的死亡率并改善非死亡率结局。此外，它将特别评估指南实施对现场插管患者亚组结局的影响.在整个研究过程中（约9年），估计约有25,000名患者入组.
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