Early Imaging Associated With Improved Survival in Older Patients With Mild Traumatic Brain Injuries
| Autor: | Brian V. Thielen, Simon Yang, Mark R. Hemmila, Christopher J. Tignanelli, Arthur S. Nguyen, Regina M. Lorenzo, Kristina Techar, Anne H. Cain-Nielsen |
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| Rok vydání: | 2019 |
| Předmět: |
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Pediatrics medicine.medical_specialty Time Factors Traumatic brain injury Improved survival Logistic regression Time-to-Treatment Head trauma 03 medical and health sciences 0302 clinical medicine Trauma Centers Older patients medicine Humans Glasgow Coma Scale Hospital Mortality Brain Concussion Aged Quality Indicators Health Care Retrospective Studies Aged 80 and over business.industry Age Factors Brain Emergency department Length of Stay Middle Aged medicine.disease Quality Improvement Benchmarking Treatment Outcome 030220 oncology & carcinogenesis Injury Severity Score Female 030211 gastroenterology & hepatology Surgery Emergency Service Hospital Tomography X-Ray Computed business |
| Zdroj: | Journal of Surgical Research. 242:4-10 |
| ISSN: | 0022-4804 |
| Popis: | Traumatic brain injury (TBI) is a leading cause of trauma-related death and disability. Computed tomography (CT) imaging of the head is essential for diagnosis of intracranial hemorrhage. This study aimed to identify optimal time to imaging and its impact on mortality for older patients with mild TBIs.State-wide quality collaborative data were used from level I-II trauma centers. Inclusion criteria were ICD-9/10 codes for head trauma, age ≥50, admission/emergency department Glasgow Coma Scale ≥14, injury severity score ≤20, nonfull trauma activation, and head CT imaging time between 5 and 90 min of arrival. Locally weighted scatterplot smoothing plot data were used to dichotomize patients into early and late head CT imaging cohorts. Multivariable logistic regression and negative binomial models were used to evaluate the effect of early verses late head CT on clinical outcomes. The primary outcome was in-hospital mortality.Mortality nadired at 35 min. Each 1-min delay in CT imaging resulted in a 2% increase in mortality (P = 0.002). Early patients had significantly reduced in-hospital mortality (P = 0.03), shorter emergency department length of stay (P 0.001), and were more likely to receive fresh frozen plasma within 4 h if anticoagulated (P = 0.03). Teaching, high-volume, and level 2 trauma centers were all less likely to provide early head CTs (all P 0.05).Delay in head CT imaging in the setting of potential mild TBI was associated with an increase in mortality. A delay in diagnosis cascades into delays in delivery of therapeutic interventions. Head CT within 35 min should be evaluated as a quality metric for older patients with mild TBI. |
| Databáze: | OpenAIRE |
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