Management of the mild traumatic brain injured patient using a multidisciplinary observation unit protocol
| Autor: | Amy Horner, Norberto Andaluz, Amanda Ventura, Uwe Stolz, Opeolu Adeoye, Natalie Kreitzer, Diana Le, Katherine Rhame, Christopher M. Miller, Laura B. Ngwenya |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Traumatic brain injury Logistic regression 03 medical and health sciences 0302 clinical medicine Clinical Observation Units Concussion medicine Humans Glasgow Coma Scale Brain Concussion Retrospective Studies business.industry 030208 emergency & critical care medicine Retrospective cohort study General Medicine Middle Aged medicine.disease Triage Hospitalization Emergency medicine Inclusion and exclusion criteria Cohort Emergency Medicine Female business Tomography X-Ray Computed |
| Zdroj: | The American journal of emergency medicine. 46 |
| ISSN: | 1532-8171 |
| Popis: | Objectives We developed an ED based multidisciplinary observation unit (OU) protocol for patients with mild traumatic brain injury (mTBI). We describe the cohort of patients who were placed in the ED OU and we evaluated if changes to our inclusion and exclusion criteria should be made. Methods We conducted a retrospective cohort study to evaluate subjects who were admitted to the mTBI observation protocol. We included adults within 24 h of sustaining an mTBI with a Glasgow Coma Scale (GCS) of 14 or 15 who had pre-specified head CT findings, and did not meet exclusion criteria. Predictors of need for hospital admission after completing the OU protocol were determined using multivariable logistic regression analysis. Results The mean age was 49 (SD 23), 58 (33%) were female, and 136 (78%) were Caucasian. No subjects discharged home required a surgical intervention or ICU admission, and there were no deaths in discharged or admitted subjects. 28 subjects (16%) were admitted to the hospital following their OU stay. Subjects admitted were older (mean age: 56 vs. 48, p = 0.1) and had a higher proportion of traumatic bleeds on head CT (85% vs. 76%, p = 0.3). In multivariable logistic regression, GCS of 15 (aOR 4.24), African-American race (aOR 5.84), and no comorbid cardiac disease predicted discharge home after the observation protocol (aOR 0.28). Conclusions A period of observation for a pre-defined cohort of patients with mTBI provided a triage plan that could allow appropriate patient management without requiring admission in the majority of subjects. |
| Databáze: | OpenAIRE |
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