Epidemiology, Prehospital Characteristics and Outcomes of Severe Traumatic Brain Injury in The Netherlands: The BRAIN-PROTECT Study

BRAIN-PROTECT collaborators., Sebastiaan M Bossers*, Christa Boer, Frank W Bloemers, Esther M M Van Lieshout, Dennis Den Hartog, Nico Hoogerwerf, Gerard Innemee, Joukje van der Naalt, Anthony R Absalom, Saskia M Peerdeman, Matthijs de Visser, Marcel A de Leeuw, Lothar A Schwarte, Stephan A Loer, Patrick Schober

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: A thorough understanding of the epidemiology, patient characteristics, trauma mechanisms, and current outcomes among patients with severe traumatic brain injury (TBI) is important as it may inform potential strategies to improve prehospital emergency care. The aim of this study is to describe the prehospital epidemiology, characteristics and outcome of (suspected) severe TBI in the Netherlands. Methods: The BRAIN-PROTECT study is a prospective observational study on prehospital management of patients with severe TBI in the Netherlands. The study population comprised all consecutive patients with clinical suspicion of TBI and a prehospital GCS score ≤ 8, who were managed by one of the 4 Helicopter Emergency Medical Services (HEMS). Patients were followed-up in 9 trauma centers until 1 year after injury. Planned sub-analyses were performed for patients with “confirmed” and “isolated” TBI. Results: Data from 2,589 patients, of whom 2,117 (81.8%) were transferred to a participating trauma center, were analyzed. The incidence rate of prehospitally suspected and confirmed severe TBI were 3.2 (95% CI: 3.1;3.4) and 2.7 (95% CI: 2.5;2.8) per 100,000 inhabitants per year, respectively. Median patient age was 46 years, 58.4% were involved in traffic crashes, of which 37.4% were bicycle related. 47.6% presented with an initial GCS of 3. The median time from HEMS dispatch to hospital arrival was 54 minutes. The overall 30-day mortality was 39.0% (95% CI: 36.8;41.2). Conclusion: This article summarizes the prehospital epidemiology, characteristics and outcome of severe TBI in the Netherlands, and highlights areas in which primary prevention and prehospital care can be improved.

Original languageEnglish
Pages (from-to)644-655
Number of pages12
JournalPrehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
Issue number5
Early online date3-Nov-2020
Publication statusPublished - 2021


  • brain injuries
  • traumatic
  • emergency medical services
  • air ambulances
  • treatment outcome
  • epidemiology
  • characteristics
  • incidence rate

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