Early Imaging Associated With Improved Survival in Older Patients With Mild Traumatic Brain Injuries

J Surg Res. 2019 Oct;242:4-10. doi: 10.1016/j.jss.2019.04.006. Epub 2019 May 3.

Abstract

Background: Traumatic brain injury (TBI) is a leading cause of trauma-related death and disability. Computed tomography (CT) imaging of the head is essential for diagnosis of intracranial hemorrhage. This study aimed to identify optimal time to imaging and its impact on mortality for older patients with mild TBIs.

Materials and methods: State-wide quality collaborative data were used from level I-II trauma centers. Inclusion criteria were ICD-9/10 codes for head trauma, age ≥50, admission/emergency department Glasgow Coma Scale ≥14, injury severity score ≤20, nonfull trauma activation, and head CT imaging time between 5 and 90 min of arrival. Locally weighted scatterplot smoothing plot data were used to dichotomize patients into early and late head CT imaging cohorts. Multivariable logistic regression and negative binomial models were used to evaluate the effect of early verses late head CT on clinical outcomes. The primary outcome was in-hospital mortality.

Results: Mortality nadired at 35 min. Each 1-min delay in CT imaging resulted in a 2% increase in mortality (P = 0.002). Early patients had significantly reduced in-hospital mortality (P = 0.03), shorter emergency department length of stay (P < 0.001), and were more likely to receive fresh frozen plasma within 4 h if anticoagulated (P = 0.03). Teaching, high-volume, and level 2 trauma centers were all less likely to provide early head CTs (all P < 0.05).

Conclusions: Delay in head CT imaging in the setting of potential mild TBI was associated with an increase in mortality. A delay in diagnosis cascades into delays in delivery of therapeutic interventions. Head CT within 35 min should be evaluated as a quality metric for older patients with mild TBI.

Keywords: Head CT imaging; Quality improvement; Quality metrics; TBI; Trauma systems improvement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Benchmarking / methods
  • Brain / diagnostic imaging*
  • Brain Concussion / diagnosis*
  • Brain Concussion / mortality
  • Brain Concussion / therapy
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Glasgow Coma Scale
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Quality Improvement
  • Quality Indicators, Health Care / statistics & numerical data
  • Retrospective Studies
  • Time Factors
  • Time-to-Treatment / statistics & numerical data
  • Tomography, X-Ray Computed / statistics & numerical data*
  • Trauma Centers / organization & administration
  • Trauma Centers / statistics & numerical data
  • Treatment Outcome