Citation

Arnold MR, Cunningham KW, Atkins TG, Haley OK, Bernard J, Seymour RB, Christmas AB, Sing RF. Am. J. Emerg. Med. 2019; ePub(ePub): ePub.

Affiliation

Division of Trauma and Acute Care Surgery, Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd., Medical Education Building, 6th floor, Charlotte, NC 28203, United States of America. Electronic address: ronald.sing@atriumhealth.org.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.ajem.2019.158379

PMID

31451302

Abstract

OBJECTIVES: Mild traumatic brain injury (mTBI) is defined as Glasgow Coma Score (GCS) of 14 or 15. Despite good outcomes, patients are commonly transferred to trauma centers for observation and/or neurosurgical consultation. The aim of this study is to assess the value of redefining mTBI with novel radiographic criteria to determine the appropriateness of interhospital transfer for neurosurgical evaluation.

METHODS: A retrospective study of patients with blunt head injury with GCS 13-15 and CT head from Jan 2014-Dec 2016 was performed. A novel criteria of head CT findings was created at our institution to classify mTBI. Outcomes included neurosurgical intervention and transfer cost.

RESULTS: A total of 2120 patients were identified with 1442 (68.0%) meeting CT criteria for mTBI and 678 (32.0%) classified high risk. Two (0.14%) patients with mTBI required neurosurgical intervention compared with 143 (21.28%) high risk TBI (p < 0.0001). Mean age (55.8 years), and anticoagulation (2.6% vs 2.8%) or antiplatelet use (2.1% vs 3.0%) was similar between groups (p > 0.05). Of patients with mTBI, 689 were transferred without receiving neurosurgical intervention. Given an average EMS transfer cost of $700 for ground and $5800 for air, we estimate an unnecessary transfer cost of $733,600.

CONCLUSION: Defining mTBI with the described novel criteria clearly identifies patients who can be safely managed without transfer for neurosurgical consultation. These unnecessary transfers represent a substantial financial and resource burden to the trauma system and inconvenience to patients.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

Computed tomography; Interhospital transfer; Neurosurgical; Traumatic brain injury