Chantanakomes, JirayuJirayuChantanakomesPansiritanachot, WasinWasinPansiritanachotRiyapan, SatthaSatthaRiyapanShin, Sang DoSang DoShinSong, Kyoung JunKyoung JunSongWEN-CHU CHIANGJamaluddin, Sabariah FaizahSabariah FaizahJamaluddinKajino, KentaroKentaroKajino2026-03-062026-03-062025-10-2814720205https://scholars.lib.ntu.edu.tw/handle/123456789/736114Background 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 (SpO2) 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 SpO2>94%), intermediate care (either SBP<110 mm Hg or SpO2<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.entruecritical care transportemergency departmentpre-hospitalpre-hospital caretraumajournal article10.1136/emermed-2024-214031411617022-s2.0-105020178864