A Criteria to Reduce Interhospital Transfer of Traumatic Brain Injuries in Greater East Texas.

Autor:	Murry J; Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Cook AD; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Swindall RJ; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Kanazawa H; Department of Graduate Medical Education, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Wadle CR; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Mohiuddin M; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Nalbach SV; Department of Neurosurgery, UT Health East Texas, Tyler, TX, USA., Le TD; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Pero BN; Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX, USA., Norwood SH; Department of Surgery, University of Texas Health Science Center at Tyler, Tyler, TX, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2024 Dec; Vol. 90 (12), pp. 3201-3208. Date of Electronic Publication: 2024 Jul 19.
DOI:	10.1177/00031348241266632
Abstrakt:	Background: Traumatic brain injury (TBI) due to single-level falls (SLF) are frequent and often require interhospital transfer. This retrospective cohort study aimed to assess the safety of a criteria for non-transfer among a subset of TBI patients who could be observed at their local hospital, vs mandatory transfer to a level 1 trauma center (L1TC). Methods: We conducted a 7-year review of patients with TBI due to SLF at a rural L1TC. Patients were classified as transfer/non-transfer according to the Brain Injuries in Greater East Texas (BIGTEX) criteria. The primary outcome measure was the occurrence of a critical event defined as deteriorating repeat head computed tomography (CT) scan or neurological status, neurosurgical intervention, or death. Results: Of the 689 included patients, 63 (9.1%) were classified as non-transfer. Although there were 4 cases with a neurological change and one with a head CT change among the non-transfer group, there were no neurosurgical procedures or deaths. The Cox Proportional Hazard model showed a near 3-fold increased risk of experiencing a critical event if classified as a non-transfer. The multivariable regression model showed patients with an Abbreviated Injury Scale (AIS) of 3 was twice as likely to experience a critical event, with an AIS of 4, three times, and 3 times more likely to be classified to transfer. Discussion: The BIGTEX criteria identify a subset of patients who can safely be observed at their local hospital. To confirm the safety and efficacy of this transfer criteria recommendation, a prospective study is warranted. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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