Introduction : Traumatic brain injury (TBI) is a critical health problem worldwide. The prognosis is directly correlated with
the precocity and quality of the Pre-hospital management. The aims of this study were to evaluate epidemiological data and
analyze the Pre-hospital management of TBI patients in Kairouan, and to compare the results obtained to those identified
in the literature review and major guidelines.
Methods : A retrospective study of 147 patients injured from January 2011 until December 31st2017 and managed by the
SMUR unit of Kairouan.
Results : The mean age was 35.3 years. The male to female ratio was 4.1. Fifty-six percent of the accidents took place in
rural areas. The most common causes were car accidents (64.6%) followed by falls (11.6%). Motorcyclists were the most
vulnerable group of road users (50.5%). The average response time was 26minutes. SpO2 was assessed in 98.6% of the
cases and hypoxia occurred in 13.8% of the cases. Endotracheal intubation was performed in 1.1% of the patients with
mild TBI, in66.7% with moderate TBI, and in92.5% with severe TBI. Blood pressure was assessed in 98% of the cases,
fluid resuscitation was used in 79.6% of the cases and the majority of the patients (88.9%) received normal saline.98.6% of
the patients were successfully transported to hospital while 1.4% deceased on their way to a healthcare center.22.4% had a
CT scan, and abnormal CT findings were seen in 60.6%ofthecases. The most common findings were cerebral contusions.
The severity of TBI appears to be influenced by the rural environment(P=0.16), accident involving motorcycles or bicycles
(p=0.045), a response time that is longer than 60minutes(p=0.006) and an associated extremity injury (p=0.045).
Conclusion : These results may contribute to the ongoing debate on the optimal Pre-hospital treatment of TBI patients.
Given the proximity to the site of impact, advances in Pre-hospital practice are a key target for further improvements in longterm
functional outcomes following TBI. Further research is needed to identify the effect of different treatment protocols
on patients’ safety and outcome.