Association between prehospital oxygen
saturation and outcomes in hypotensive

traumatic brain injury patients in Asia (Pan-
Asian Trauma Outcomes Study (PATOS))

Association between prehospital oxygen
saturation and outcomes in hypotensive

traumatic brain injury patients in Asia (Pan-
Asian Trauma Outcomes Study (PATOS))

Hypoxia, Hypotension, Trauma, Brain injury, Survival, Disability

Abstract
Background It has been shown that blood pressure (BP) and peripheral oxygen saturation (SpO2) influence the
outcomes in Traumatic Brain Injury (TBI) patients. This study aims to determine the association between prehospital
SpO2 and in-hospital mortality in hypotensive TBI patients.
Methods Prehospital trauma patients who were 18 years old or above with a diagnosis of TBI using ICD 10 codes
(S06.0-S06.9) and had prehospital hypotension (systolic blood pressure (SBP)<100 mmHg for patients aged 50–69
and <110 mmHg for patients aged 15–49 or over 70 years) recorded from November 2015 to December 2022 in
participating PATOS facilities were analyzed. SpO2 was measured by Emergency Medical Services (EMS) and divided
into three levels: normoxia (≥94%), moderate hypoxia (80–93%), and severe hypoxia (<80%). The outcomes were
survival and disability at hospital discharge. Multivariable logistic regression analysis with interaction analysis was
performed to calculate the adjusted odds ratios (AORs) with 95% confidence intervals (CIs).
Results Out of 1,210 patients, 777 (64.2%) had normoxia, 319 (26.4%) had moderate hypoxia and 114 (9.4%) had
severe hypoxia. Of these, survival to discharge was 92.5%, 74.9%, and 52.6% in the normoxia, moderate hypoxia, and
severe hypoxia group, respectively (p<0.0001). Favorable neurological outcomes in normoxia, moderate hypoxia, and
severe hypoxia were 74.1%, 48.9 and 36%, respectively. AORs (95% CI) for survival and favorable neurological outcome
compared with severe hypoxia were 3.34 (1.77–6.32)/1.83 (1.04–3.25) in the normoxia group and 2.15 (1.23–3.74)/2.23
(1.31–3.78) in the moderate hypoxia group respectively.
Conclusion An initial prehospital saturation of ≥94% was significantly associated with better hospital outcomes in
hypotensive TBI patients.
Keywords Hypoxia, Hypotension, Trauma, Brain injury, Survival, Disability

Netiporn Thirawattanasoot1

, Jirayu Chantanakomes1*, Wasin Pansiritanachot1

, Wichayada Rangabpai1
,

Usapan Surabenjawong1

, Wansiri Chaisirin1

, Sattha Riyapan1

, Sang Do Shin2

, Kyoung Jun Song3

, Wen-Chiu Chiang4
,

Sabariah Faizah Jamaluddin5

and Kentaro Kajino6

https://doi.org/10.1186/s12245-025-00914-3

2025

Peri Irawan

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