Association between pre-hospital National Early Warning Score and in-hospital mortality in patients with traumatic brain injury

BACKGROUND: This study aimed to examine the association between the outcome of traumatic brain injury (TBI) and pre-hospital National Early Warning Score (NEWS), Injury Severity Score (ISS), and Revised Trauma Score (RTS). METHODS: This retrospective and observational study included adult patients with TBI admitted to the pre-hospital emergency medical services system between January 2019 and December 2020. TBI was considered when the abbreviated injury scale score was 3 or higher. The primary outcome was in-hospital mortality. RESULTS: Among 248 patients included in the study, in-hospital mortality was 18.5% (n=46). In the multivariate analysis for predict-ing in-hospital mortality, pre-hospital NEWS (Odds ratio [OR], 1.198; 95% Confidence interval [CI], 1.042-1.378) and RTS (OR, 0.568; 95% CI, 0.422-0.766) were independently associated with in-hospital mortality. The area under the curves (AUCs) for ISS, RTS, and pre-hospital NEWS were 0.731 (95% CI, 0.672-0.786), 0.853 (95% CI, 0.802-0.894), and 0.843 (95% CI, 0.791-0.886), respectively. The AUC of pre-hospital NEWS was significantly different from that of ISS but not from that of RTS. CONCLUSION: Pre-hospital NEWS could contribute to improving prognosis by aiding in the rapid classification of patients with TBI in the field and their transportation to appropriate hospitals.