Over the last several years there has been a gradual shift in management of mild traumatic brain injury (TBI) at the University of Arizona Medical Center’s Level 1 trauma center, and it’s paying off, researchers say.
“We have adopted the practice of managing low-risk patients with mild TBI without the need for a repeat head computed tomography or a neurosurgical consultation by establishing and implementing a simple clinical guideline-based protocol,” study author Bellal Joseph, MD, and colleagues explained.
They assessed the impact of this change in management on patient-related outcomes and resource use over five years, and report their observations in the September issue of Annals of Surgery.
Their analysis included all 2,184 patients with TBI presenting from 2009 to 2014. They had a median Glasgow Coma Scale (GCS) score of 15 (interquartile range, 12–15), and median head-abbreviated injury scale score of 3 (interquartile range, 2–4), with no change throughout the study period in the types and size of intracranial bleeds.
Over the years, there was a significant increase in the proportion of TBI managed exclusively by trauma surgeons, from 6.8 percent to 40.1 percent (p<0.001). There was also a significant decrease over time in the proportion of patients who received neurosurgical consultations and repeat head CT scans (both p<0.001), time spent in the hospital (p=0.028), and costs (p<0.001).
The overall mortality rate was 18.5 percent and remained unchanged over the years.
“In our study, we observed decreasing trends in the rate of repeat head CT scan and neurosurgical consultation in patients with intracranial hemorrhage at our trauma center,” Dr. Joseph and colleagues noted in their article. “Along with this change in practice, we also observed trends for expedited patient discharge and reduced hospital costs over time. Despite a seemingly aggressive change in practice, no change in mortality rate or discharge GCS was observed over the years.”
“We demonstrate,” the authors wrote, “how an evidence-based and protocol-driven change in practice can standardize patient care and help improve resource allocation without adversely affecting patient care. In an era where financial costs of health care cannot be ignored, and where the neurosurgical coverage remains inadequate, our center’s experience demonstrates how a collaborative approach with other services can help tackle these shortcomings.”
The study had no funding and the authors have no conflicts of interest.