Association of prehospital optimal blood pressure and peripheral oxygen saturation with hospital outcomes in sports-related and recreation-related traumatic brain injury (SRR-TBI) in Asia

Background: While Emergency Medical Services (EMS) guidelines improve outcomes in severe traumatic brain injury (TBI), the effect of optimal blood pressure and oxygenation on sports-related and recreation-related TBI (SRR-TBI) is unclear. This study assessed whether EMS management of systolic blood pressure (SBP) and oxygen saturation (SpO_₂) influences outcomes in SRR-TBI. Methods: This retrospective cohort study analysed data from patients diagnosed with TBI sustaining injuries during sports, education or leisure activities and were transported by EMS from 1 January 2016 to 31 December 2022, at Pan-Asian Trauma Outcomes Study facilities. Patients were classified as receiving optimal care (SBP>110 mm Hg and SpO_₂>94%), intermediate care (either SBP<110 mm Hg or SpO_₂<94%) or suboptimal care (both <thresholds). Outcomes were favourable neurological recovery (Modified Rankin Scale 0–3) and survival to discharge. Adjusted ORs with 95% CIs were calculated using multivariable logistic regression, adjusting for activity, age, sex, Charlson Comorbidity Index, mechanism and intent of injury, alcohol intake, time of injury and the Excess Mortality Ratio-adjusted Injury Severity Score. Results: Among 4629 patients, 74% were male and 18.4% were <18 years old. Injuries occurred during education (3%), sports (14.5%) and leisure (82.5%). Care was optimal in 77.7%, intermediate in 19.6% and suboptimal in 2.7%. Favourable outcomes were 96.3%, 88.7% and 76%, with mortality of 0.9%, 4.7% and 8.8%, respectively (p<0.0001). Compared with suboptimal care, adjusted odds of favourable recovery and survival were 2.76 and 3.30 for optimal care, and 1.27 and 1.01 for intermediate care. Conclusion: Maintaining optimal SBP and SpO₂ during EMS care is associated with better neurological outcomes and survival in patients with SRR-TBI.