Factors correlating with delayed trauma center admission following traumatic brain injury

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Markus B Skrifvars¹  Jaakko Lappalainen³  Tuomas Brinck²  Markku Kuisma¹  Riku Kivisaari³  Jari Siironen³  Rahul Raj³ 

[1] Department of Anesthesiology, Intensive Care, Emergency Care and Pain management, Helsinki University Central Hospital, Helsinki, Finland;Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland;Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland

关键词: Emergency medical service;    Outcome;    Triage;    Transport;    Pre-hospital;    Traumatic brain injury;   

Others  :  810762
DOI  :  10.1186/1757-7241-21-67

 received in 2013-05-10, accepted in 2013-09-08,  发布年份 2013

【 摘 要 】

Background

Delayed admission to appropriate care has been shown increase mortality following traumatic brain injury (TBI). We investigated factors associated with delayed admission to a hospital with neurosurgical expertise in a cohort of TBI patients in the intensive care unit (ICU).

Methods

A retrospective analysis of all TBI patients treated in the ICUs of Helsinki University Central Hospital was carried out from 1.1.2009 to 31.12.2010. Patients were categorized into two groups: direct admission and delayed admission. Patients in the delayed admission group were initially transported to a local hospital without neurosurgical expertise before inter-transfer to the designated hospital. Multivariate logistic regression was utilized to identify pre-hospital factors associated with delayed admission.

Results

Of 431 included patients 65% of patients were in the direct admission groups and 35% in the delayed admission groups (median time to admission 1:07h, IQR 0:52–1:28 vs. 4:06h, IQR 2:53–5:43, p <0.001). In multivariate analysis factors increasing the likelihood of delayed admission were (OR, 95% CI): male gender (3.82, 1.60-9.13), incident at public place compared to home (0.26, 0.11-0.61), high energy trauma (0.05, 0.01-0.28), pre-hospital physician consultation (0.15, 0.06-0.39) or presence (0.08, 0.03-0.22), hypotension (0.09, 0.01-0.93), major extra cranial injury (0.17, 0.05-0.55), abnormal pupillary light reflex (0.26, 0.09-0.73) and severe alcohol intoxication (12.44, 2.14-72.38). A significant larger proportion of patients in the delayed admission group required acute craniotomy for mass lesion when admitted to the neurosurgical hospital (57%, 21%, p< 0.001). No significant difference in 6-month mortality was noted between the groups (p= 0.814).

Conclusion

Delayed trauma center admission following TBI is common. Factors increasing likelihood of this were: male gender, incident at public place compared to home, low energy trauma, absence of pre-hospital physician involvement, stable blood pressure, no major extra cranial injuries, normal pupillary light reflex and severe alcohol intoxication. Focused educational efforts and access to physician consultation may help expedite access to appropriate care in TBI patients.

【 授权许可】

   
2013 Raj et al.; licensee BioMed Central Ltd.

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