Head CT before Transfer Does Not Decrease Time to Craniotomy for TBI Patients

Am Surg. 2018 Feb 1;84(2):201-207.


Rural trauma education emphasizes that radiologic imaging should be discouraged if it delays transfer to definitive care. With increased capacity for image sharing, however, radiography obtained at referring hospitals (RH) could help providers at trauma centers (TC) prepare for patients with traumatic brain injury. We evaluated whether a head CT prior to transfer accelerated time to neurosurgical intervention at the TC. The study was conducted at a combined adult Level I and pediatric Level II TC with a catchment area that includes rural hospitals within a 150 mile radius. The trauma registry was used to identify patients with traumatic brain injury who went to surgery for a neurosurgical procedure immediately after arrival at the TC. All patients were transferred in from a RH. Differences between groups were assessed using analysis of variance and chi-square. Fifty-six patients met study criteria during the study period (2010-2015). The majority (86%) of patients received head CT imaging at the RH, including a significant percentage of patients (18%) who presented with GCS ≤8. There was no statistically significant decrease in time to surgery when patients received imaging at the RH. CT imaging was associated with a delay in transfer that exceeded 90 minutes. Findings demonstrate that imaging at the RH delayed transfer to definitive care and did not improve time to neurosurgical intervention at the TC. Transfer to the TC should not be obstructed by imaging, especially for patients with severe TBI.

MeSH terms

  • Adult
  • Aged
  • Brain Injuries, Traumatic / diagnostic imaging*
  • Brain Injuries, Traumatic / surgery
  • Craniotomy*
  • Female
  • Hospitals, Rural*
  • Humans
  • Iowa
  • Male
  • Middle Aged
  • Patient Transfer*
  • Retrospective Studies
  • Time Factors
  • Tomography, X-Ray Computed*
  • Trauma Centers*