***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The utility of advanced prehospital interventions for severe blunt traumatic brain injury ( BTI ) remains controversial . Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention . Supporting evidence is largely lacking however . In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate . Methods This article describes the design and protocol of the Head Injury Retrieval Trial ( HIRT ) which is a r and omised controlled single centre trial of physician prehospital care ( delivering advanced interventions such as rapid sequence intubation and blood transfusion ) in addition to paramedic care for severe blunt TBI  compared with paramedic care alone . Results Primary endpoint is Glasgow Outcome Scale score at six months post injury . Issues with trial integrity result ing from drop ins from st and ard care to the treatment arm as the result of policy changes by the local ambulance system are discussed . Conclusion This r and omised controlled trial will contribute to the evaluation of the efficacy of advance prehospital interventions in severe blunt TBI.Trial Registration Clinical Trials.gov : Background Advanced prehospital interventions for severe brain injury remains controversial . No previous r and omised trial has been conducted to evaluate additional physician intervention compared with paramedic only care . Methods Participants in this prospect i ve , r and omised controlled trial were adult patients with blunt trauma with either a scene GCS score < 9 ( original definition ) , or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 ( modified definition ) . Patients were r and omised to either st and ard ground paramedic treatment or st and ard treatment plus a physician arriving by helicopter .  Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale ( GOS ) scores . Due to high non-compliance rates , both intention-to-treat and as-treated analyses were preplanned . Results 375 patients met the original definition , of which 197 was allocated to physician care . Differences in the 6-month GOS scores were not significant on intention-to-treat analysis ( OR 1.11 , 95 % CI 0.74 to 1.66 , p=0.62 ) nor was the 30-day mortality ( OR 0.91 , 95 % CI 0.60 to 1.38 , p=0.66 ) . As-treated analysis showed a 16 % reduction in 30-day mortality in those receiving additional physician care ; 60/195 ( 29 % ) versus 81/180 ( 45 % ) , p<0.01 , Number needed to treat = 6 . 338 patients met the modified definition , of which 182 were allocated to physician care . The 6-month GOS scores were not significantly different on intention-to-treat analysis ( OR 1.14 , 95 % CI 0.73 to 1.75 , p=0.56 ) nor was the 30-day mortality ( OR 1.05 , 95 % CI 0.66 to 1.66 , p=0.84 ) . As-treated analyses were also not significantly different . Conclusions This trial suggests a potential mortality reduction in patients with blunt trauma with GCS<9 receiving additional physician care ( original definition only ) . Confirmatory studies which also address non-compliance issues are needed . Trial registration number NCT00112398 To determine whether the presence of a physician in the prehospital setting influences patient outcome , the predicted mortality of 258 patients with blunt trauma treated and transported by a medical helicopter staffed by a flight nurse and flight paramedic  was compared with that of 316 similar patients with blunt trauma treated and transported by a medical helicopter staffed by a flight nurse and flight physician . All patients were r and omized between the two treatment teams . The mortality of the patients treated by the flight nurse/flight paramedic team was that predicted by the methodology . The mortality of the patients treated by the flight nurse/flight physician team was 35 % lower than that predicted , and significantly lower than that of the flight nurse/flight paramedic-staffed helicopter The early prediction of outcome after traumatic brain injury ( TBI ) is important for several purpose s , but no prognostic models have yet been developed with proven generalizability across different setting s. The objective of this study was to develop and vali date prognostic models that use information available at admission to estimate 6-month outcome after severe or moderate TBI . To this end , this study evaluated mortality and unfavorable outcome , that is , death , and vegetative or severe disability on the Glasgow Outcome Scale ( GOS ) , at 6 months post-injury . Prospect ively collected data on 2269 patients from two multi-center clinical trials were used to develop prognostic models for each outcome with logistic regression analysis . We included seven predictive characteristics-age , motor score , pupillary reactivity , hypoxia , hypotension , computed tomography classification , and traumatic subarachnoid hemorrhage . The models were vali date d internally with bootstrapping techniques . External validity was determined in prospect ively collected data from two relatively unselected surveys in Europe ( n = 796 ) and in North America ( n = 746 ) . We evaluated the discriminative ability , that is , the ability to distinguish patients with different outcomes , with the area under the receiver operating characteristic curve ( AUC ) . Further , we determined calibration , that is , agreement between predicted and observed outcome , with the Hosmer-Lemeshow goodness-of-fit test . The models discriminated well in the development population ( AUC 0.78 - 0.80 ) . External validity was even better ( AUC 0.83 - 0.89 ) . Calibration was less satisfactory , with poor external validity in the North American survey ( p < 0.001 ) . Especially , observed risks were higher than predicted for poor prognosis patients . A score chart was derived from the regression models to facilitate clinical application . Relatively simple prognostic models using baseline characteristics can accurately predict 6-month outcome in patients with severe or moderate TBI . The high discriminative ability indicates the potential of this model for classifying patients according to prognostic risk BACKGROUND The primary aim of this study was to assess the health-related quality of life of survivors of severe trauma 1 year after injury , specified according to all the separate dimensions of the EuroQol-5D ( EQ-5D ) and the Health Utilities Index ( HUI ) . METHODS A prospect i ve cohort study was conducted in which all severely injured trauma patients presented at a Level I trauma center were included . After 12 months , the EQ-5D , HUI2 and HUI3 were used to analyze the health status . RESULTS Follow-up assessment s were obtained from 246 patients ( response rate , 68 % ) . The overall population EQ-5D ( median ) utility score was 0.73 ( EQ-5D Dutch general population norm , 0.88 ) . HUI2 , HUI3 , and EQ-5D Visual Analog Scale scores were 0.81 , 0.65 , and 70 , respectively . Eighteen percent had at least one functional limitation 1 year after trauma , and 60 % reported functional limitations on two or more domains using the EQ-5D . The female gender and comorbidity were significant independent predictors of disability . CONCLUSION Functional outcome and quality of life of survivors of severe injury have not returned to normal 1 year after trauma . The prevalence of specific limitations in this population is very high ( 40 - 70 % ) . Female gender and comorbidity are predictors of long-term disability OBJECTIVE To evaluate the effect of paramedic rapid sequence intubation ( RSI ) on outcome in patients with severe traumatic brain injury . METHODS Adult major trauma victims were prospect ively enrolled over two years using the following inclusion criteria : Glasgow Coma Scale ( GCS ) 3 - 8 , suspected head injury by mechanism or physical examination , transport time > 10 , " and inability to intubate without RSI .  Midazolam and succinylcholine were administered before laryngoscopy ; rocuronium was given after tube placement was confirmed using physical examination , capnometry , syringe aspiration , and pulse oximetry . The Combitube was used as a salvage airway device . For this analysis , trial patients were excluded for absence of a head injury ( Head/Neck AIS score < 2 ) , failure to fulfill major trauma outcome study criteria , unsuccessful intubation or Combitube insertion , or death in the field or in the resuscitation suite within 30 " of arrival . Each study patient was h and matched to three nonintubated historical controls from our trauma registry using the following parameters : age , sex , mechanism of injury , trauma center , and AIS score for each body system . Controls were excluded for Head/Neck AIS defined by a c-spine injury or death in the field or in the resuscitation suite within 30 " of arrival . chi 2 , odds ratios , and logistic regression were used to investigate the impact of RSI on the primary outcome measures of mortality and incidence of a " good outcome , " defined as discharge to home , rehabilitation , psychiatric facility , jail , or signing out against medical advice . RESULTS A total of 209 trial patients were h and matched to 627 controls . The groups were similar with regard to all matching parameters , admission vital signs , frequency of specific head injury diagnoses , and incidence of invasive procedures . Mortality was significantly increased in the trial cohort versus controls for all patients ( 33.0 % versus 24.2 % , p < 0.05 ) and in those with Head/Neck AIS scores of 3 or greater ( 41.1 % versus 30.3 % , p < 0.05 ) . The incidence of a " good outcome " was lower in the trial cohort versus controls ( 45.5 % versus 57.9 % , p < 0.01 ) . Factors that may have contributed to the increase in mortality include transient hypoxia , inadvertent hyperventilation , and longer scene times associated with the RSI procedure . CONCLUSION Paramedic RSI protocol s to facilitate intubation of head-injured patients were associated with an increase in mortality and decrease in good outcomes versus matched historical controls OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Objective : To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury ( TBI ) improves neurologic outcomes at 6 months compared with intubation in the hospital . Background : Severe TBI is associated with a high rate of mortality and long-term morbidity . Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway , prevent hypoxia , and control ventilation . In many places , paramedics perform intubation prior to hospital arrival . However , it is unknown whether this approach improves outcomes . Methods : In a prospect i ve , r and omized , controlled trial , we assigned adults with severe TBI in an urban setting to either  prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians . The primary outcome measure was the median extended Glasgow Outcome Scale ( GOSe ) score at 6 months . Secondary end-points were favorable versus unfavorable outcome at 6 months , length of intensive care and hospital stay , and survival to hospital discharge . Results : A total of 312 patients with severe TBI were r and omly assigned to paramedic rapid sequence intubation or hospital intubation . The success rate for paramedic intubation was 97 % . At 6 months , the median GOSe score was 5 ( interquartile range , 1–6 ) in patients intubated by paramedics compared with 3 ( interquartile range , 1–6 ) in the patients intub 
    Output:
    
There appears to be an association between prehospital management by doctors and improved survival in major trauma .
There may also be an association with improved survival and better functional outcomes in severe traumatic brain injury .