The impact of delayed time to first CT head in traumatic brain injury

Morgan Schellenberg; Elizabeth Benjamin; Natthida Owattanapanich; Kenji Inaba; Demetrios Demetriades

doi:10.1007/s00068-020-01421-1

The impact of delayed time to first CT head in traumatic brain injury

Eur J Trauma Emerg Surg. 2021 Oct;47(5):1511-1516. doi: 10.1007/s00068-020-01421-1. Epub 2020 Jun 25.

Authors

Morgan Schellenberg¹, Elizabeth Benjamin², Natthida Owattanapanich², Kenji Inaba², Demetrios Demetriades²

Affiliations

¹ Division of Trauma and Surgical Critical Care. LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA. morgan.schellenberg@med.usc.edu.
² Division of Trauma and Surgical Critical Care. LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA.

Abstract

Purpose: Trauma team activation (TTA) criteria trigger early mobilization of resources for the sickest trauma patients. Patients with moderately depressed GCS who do not trigger the highest level activation are at risk for adverse outcomes, potentially from delayed time to intervention. The study objective was to define the impact of time to first CT Head (CTH) on outcomes among blunt trauma patients with moderately depressed GCS.

Methods: Patients from the Trauma Quality Improvement Program (TQIP) databank (2013-2016) with first ED GCS 9-12 were included. Transfers, penetrating mechanisms, death < 24 h, AIS = 6 in any body region, and patients with severe associated injuries were excluded. Study groups were defined by time to first CTH after ED arrival: immediate (≤ 1 h) vs. delayed (1-6 h). Primary outcomes were time to neurosurgical intervention and time to ED discharge.

Results: After exclusions, 4997 patients were identified. Of these, 79% (n = 3,954) underwent immediate CTH and 21% (n = 1,043) had delayed CTH. Median GCS was 11 [10-12] in both groups and there was no difference in median Head AIS (4 [3-4] vs. 4 [3-4], p = 0.586). Time to craniotomy and ICP monitor insertion were longer in the delayed group (4.2 h [3.0-7.6] vs. 3.1 h [2.1-8.7], p = 0.001; and 5.7 h [3.8-13.0] vs. 4.4 h [2.6-12.0], p = 0.008), as was time in the ED (4.3 h [2.7-6.5] vs. 2.1 h [1.2-3.7], p < 0.001). There was no difference in need for craniotomy (11% vs. 10%, p = 0.287), need for ICP monitor (12% vs. 12%, p = 0.899), or mortality (11% vs. 9%, p = 0.160). On multivariate analysis, age > 65 (OR 2.813, p < 0.001), SBP < 90 mmHg (OR 2.934, p < 0.001), ED intubation (OR 1.486, p = 0.001), and Head AIS scores of 4 (OR 1.884, p < 0.001) and 5 (OR 6.729, p < 0.001) were independently associated with death.

Conclusions: Immediate CTH for blunt trauma patients with moderately depressed GCS decreases time to intervention and reduces ED time. A protocol to shorten time to CTH may be beneficial for both patients and hospitals.

Keywords: Computed tomography of the head; Time to intervention; Trauma; Traumatic brain injury; Undertriage.

MeSH terms

Brain Injuries, Traumatic*
Glasgow Coma Scale
Humans
Monitoring, Physiologic
Quality Improvement
Tomography, X-Ray Computed
Wounds, Nonpenetrating*