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World Journal of Emergency Surgery

, 8:48

First Online: 18 November 2013Received: 17 September 2013Accepted: 31 October 2013

Abstract

BackgroundTraumatic brain injury TBI constitutes the leading cause of posttraumatic mortality. Practically, the major interventions required to treat TBI predicate expedited transfer to CT after excluding other immediately life-threatening conditions. At our center, trauma responses variably consist of either full trauma activation FTA including an attending trauma surgeon or a non-trauma team response NTTR. We sought to explore whether FTAs expedited the time to CT head TTCTH.

MethodsRetrospective review of augmented demographics of 88 serious head injuries identified from a Regional Trauma Registry within one year at a level I trauma center. The inclusion criteria consisted of a diagnosis of head injury recorded as intubated or GCS < 13; and CT-head scanning after arriving the emergency department. Data was analyzed using STATA.

ResultsThere were 58 FTAs and 30 NTTRs; 86% of FTAs and 17% of NTTRs were intubated prehospital out of 101 charts reviewed in detail; 13 were excluded due to missing data. Although FTAs were more seriously injured median ISS 29, MAIS head 19, GCS score at scene 6.0, NTTRs were also severely injured median ISS 25, MAIS head 21, GCS at scene 10 and older median 54 vs. 26 years. Median TTCTH was double without dedicated FTA median 50 vs. 26 minutes, p < 0.001, despite similar justifiable delays 53% NTTR, 52% FTA. Without FTA, most delays 69% were for emergency intubation. TTCTH after securing the airway was longer for NTTR group median 38 vs. 26 minutes, p =0.0013. Even with no requirements for ED interventions, TTCTH for FTA was less than half versus NTTR 25 vs. 61 minutes, p =0.0013. Multivariate regression analysis indicated age and FTA with an attending surgeon as significant predictors of TTCTH, although the majority of variability in TTCTH was not explained by these two variables R² = 0.33.

ConclusionFull trauma activations involving attending trauma surgeons were quicker at transferring serious head injury patients to CT. Patients with FTA were younger and more seriously injured. Discerning the reasons for delays to CT should be used to refine protocols aimed at minimizing unnecessary delays and enhancing workforce efficiency and clinical outcome.

KeywordsTrauma triage Trauma activation Trauma human factors Traumatic brain injury Diagnostic imaging AbbreviationsACS COTAmerican College of Surgeons Committee on Trauma

BPBlood pressure

CTComputed tomography

EDEmergency department

FASTFocused assessment with sonography

FMCFoothills Medical Centre

FTAFull trauma activation

GCSGlasgow coma scale

ICUIntensive care unit

ISSInjury severity score

IQRInterquartile ranges

LOSLength of stay

MAISMaximum abbreviated injury scale

NTTRNon-trauma team response

PACSPicture archiving and communication system

TBITraumatic brain injury

TTCTHTime to CT head.

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Author: Alma Rados - Corina Tiruta - Zhengwen Xiao - John B Kortbeek - Paul Tourigny - Chad G Ball - Andrew W Kirkpatrick

Source: https://link.springer.com/







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