Pathway-Based Reduction of Repeat Head Computed Tomography for Patients With Complicated Mild Traumatic Brain Injury: Implementation and Outcomes
| Autor: | Jennifer M. Singleton, Charles S. Parsons, Carrie Tibbles, Roger B. Davis, Emmalin B. Nelton, Stacey Keith, Jonathan A. Edlow, Martina Stippler, Leslie A Bilello, Carlo L. Rosen |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Traumatic brain injury medicine.medical_treatment Population Neuroimaging Computed tomography Young Adult 03 medical and health sciences 0302 clinical medicine Medical imaging Delayed surgery medicine Humans Glasgow Coma Scale Prospective Studies education Brain Concussion Reduction (orthopedic surgery) Aged Retrospective Studies Aged 80 and over education.field_of_study medicine.diagnostic_test Diagnostic Tests Routine business.industry 030208 emergency & critical care medicine Middle Aged medicine.disease Triage Treatment Outcome Research—Human—Clinical Studies Female Surgery Radiology Neurology (clinical) Tomography X-Ray Computed business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Neurosurgery |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1093/neuros/nyaa504_s112 |
| Popis: | Background Routine follow-up head imaging in complicated mild traumatic brain injury (cmTBI) patients has not been shown to alter treatment, improve outcomes, or identify patients in need of neurosurgical intervention. We developed a follow-up head computed tomography (CT) triage algorithm for cmTBI patients to decrease the number of routine follow-up head CT scans obtained in this population. Objective To report our experience with protocol implications and patient outcome. Methods Data on all cmTBI patients presenting from July 1, 2018 to June 31, 2019, to our level 1, tertiary, academic medical center were collected prospectively and analyzed retrospectively. Descriptive analysis was performed. Results Of the 178 patients enrolled, 52 (29%) received a follow-up head CT. A total of 27 patients (15%) were scanned because of initial presentation and triaged to the group to receive a routine follow-up head CT. A total of 151 patients (85%) were triaged to the group without routine follow-up head CT scan. Protocol adherence was 89% with 17 violations. Conclusion Utilizing this protocol, we were able to safely decrease the use of routine follow-up head CT scans in cmTBI patients by 71% without any missed injuries or delayed surgery. Adoption of the protocol was high among all services managing TBI patients. |
| Databáze: | OpenAIRE |
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