Does on-scene resuscitation affect in-hospital "do not resuscitate" decisions and mortality in patients with severe head injuries?

To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). The DNR and mortality rates within the first 48 hours (13%, 10%, 10%, respectively) as well as for the entire stay in the surgical intensive care unit (SICU) were comparable for the three groups. It has been pointed out that efficient resuscitation at the scene of the injury may, instead of improving overall outcome, increase morbidity and mortality rates because more severely injured patients now reach the hospital alive. We conclude, however, that primary aggressive treatment at the scene of the injury did not increase DNR and in-hospital mortality rates within the 48-hour follow-up period, nor for the total stay in the SICU. Investigation of long-term outcome will be important to further establish the efficacy of this approach.