{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T18:32:54Z","timestamp":1794335574031,"version":"4.9.0"},"reference-count":12,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T00:00:00Z","timestamp":1714348800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X24000359_as1\"><jats:title>Objective:<\/jats:title><jats:p>Hemodynamic collapse in multi-trauma patients with severe traumatic brain injury (TBI) poses both a diagnostic and therapeutic challenge for prehospital clinicians. Brain injury associated shock (BIAS), likely resulting from catecholamine storm, can cause both ventricular dysfunction and vasoplegia but may present clinically in a manner similar to hemorrhagic shock. Despite different treatment strategies, few studies exist describing this phenomenon in the early post-injury phase. This retrospective observational study aimed to describe the frequency of shock in isolated TBI in prehospital trauma patients and to compare their clinical characteristics to those patients with hemorrhagic shock and TBI without shock.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X24000359_as2\"><jats:title>Methods:<\/jats:title><jats:p>All prehospital trauma patients intubated by prehospital medical teams from New South Wales Ambulance Aeromedical Operations (NSWA-AO) with an initial Glasgow Coma Scale (GCS) of 12 or less were investigated. Shock was defined as a pre-intubation systolic blood pressure under 90mmHg and the administration of blood products or vasopressors. Injuries were classified from in-hospital computed tomography (CT) reports. From this, three study groups were derived: BIAS, hemorrhagic shock, and isolated TBI without shock. Descriptive statistics were then produced for clinical and treatment variables.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X24000359_as3\"><jats:title>Results:<\/jats:title><jats:p>Of 1,292 intubated patients, 423 had an initial GCS of 12 or less, 24 patients (5.7% of the original cohort) had shock with an isolated TBI, and 39 patients had hemorrhagic shock. The hemodynamic parameters were similar amongst these groups, including values of tachycardia, hypotension, and elevated shock index. Prehospital clinical interventions including blood transfusion and total fluids administered were also similar, suggesting they were indistinguishable to prehospital clinicians.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X24000359_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Hemodynamic compromise in the setting of isolated severe TBI is a rare clinical entity. Current prehospital physiological data available to clinicians do not allow for easy delineation between these patients from those with hemorrhagic shock.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x24000359","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T07:17:31Z","timestamp":1714375051000},"page":"251-256","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":8,"title":["Brain Injury Associated Shock: An Under-Recognized and Challenging Prehospital Phenomenon"],"prefix":"10.1017","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-4386","authenticated-orcid":false,"given":"Christopher","family":"Partyka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Alexiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Bliss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5251-7939","authenticated-orcid":false,"given":"Matthew","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5915-6315","authenticated-orcid":false,"given":"Ian","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,4,29]]},"reference":[{"key":"S1049023X24000359_ref5","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/5842182"},{"key":"S1049023X24000359_ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-009-0071-0"},{"key":"S1049023X24000359_ref10","unstructured":"10. Ferguson, I , Miller, M , Bliss, J , Partyka, C. NSW Aeromedical Operations Airway Database Project. https:\/\/osf.io\/6rzg8. Accessed December 2023."},{"key":"S1049023X24000359_ref2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000100381.89107.93"},{"key":"S1049023X24000359_ref1","doi-asserted-by":"publisher","DOI":"10.3171\/2017.10.JNS17352"},{"key":"S1049023X24000359_ref9","doi-asserted-by":"publisher","DOI":"10.1111\/aas.14177"},{"key":"S1049023X24000359_ref11","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2020-209635"},{"key":"S1049023X24000359_ref12","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005110"},{"key":"S1049023X24000359_ref7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.678995"},{"key":"S1049023X24000359_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(02)01052-8"},{"key":"S1049023X24000359_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2018.04.019"},{"key":"S1049023X24000359_ref4","doi-asserted-by":"publisher","DOI":"10.1097\/EA9.0000000000000029"}],"container-title":["Prehospital and Disaster Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1049023X24000359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T09:21:29Z","timestamp":1742376089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1049023X24000359\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,29]]},"references-count":12,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["S1049023X24000359"],"URL":"https:\/\/doi.org\/10.1017\/s1049023x24000359","relation":{},"ISSN":["1049-023X","1945-1938"],"issn-type":[{"value":"1049-023X","type":"print"},{"value":"1945-1938","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,29]]},"assertion":[{"value":"\u00a9 The Author(s), 2024. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}