Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Original Research

Kjetil Thorsen¹  Elisabeth Jeppesen²  Mathias Cuevas-Østrem³  Olav Røise⁴  Torben Wisborg⁵  Eirik Helseth⁶ 

[1] Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway;Faculty of Health Sciences, University of Stavanger, Stavanger, Norway;Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway;Faculty of Health Sciences, University of Stavanger, Stavanger, Norway;Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway;Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway;C/O Norwegian Air Ambulance Foundation, Postboks 414 Sentrum, 0103, Oslo, Norway;Faculty of Health Sciences, University of Stavanger, Stavanger, Norway;Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway;Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway;INTEREST: Interprofessional Rural Research Team-Finnmark, Faculty of Health Sciences, University of Tromsø-the Arctic University of Norway, Hammerfest, Norway;Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway;Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway;Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Neurosurgery, Oslo University Hospital, Oslo, Norway;

关键词: Traumatic Brain Injury;    Trauma system;    Transfer;    Interhospital;    Geriatric;   

DOI  :  10.1186/s13049-023-01097-7

 received in 2023-04-15, accepted in 2023-06-13,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSystems ensuring continuity of care through the treatment chain improve outcomes for traumatic brain injury (TBI) patients. Non-neurosurgical acute care trauma hospitals are central in providing care continuity in current trauma systems, however, their role in TBI management is understudied. This study aimed to investigate characteristics and care pathways and identify factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe TBI primarily admitted to acute care trauma hospitals.MethodsA population-based cohort study from the national Norwegian Trauma Registry (2015–2020) of adult patients (≥ 16 years) with isolated moderate-to-severe TBI (Abbreviated Injury Scale [AIS] Head ≥ 3, AIS Body < 3 and maximum 1 AIS Body = 2). Patient characteristics and care pathways were compared across transfer status strata. A generalized additive model was developed using purposeful selection to identify factors associated with transfer and how they affected transfer probability.ResultsThe study included 1735 patients admitted to acute care trauma hospitals, of whom 692 (40%) were transferred to neurotrauma centers. Transferred patients were younger (median 60 vs. 72 years, P < 0.001), more severely injured (median New Injury Severity Score [NISS]: 29 vs. 17, P < 0.001), and had lower admission Glasgow Coma Scale (GCS) scores (≤ 13: 55% vs. 27, P < 0.001). Increased transfer probability was significantly associated with reduced GCS scores, comorbidity in patients < 77 years, and increasing NISSs until the effect was inverted at higher scores. Decreased transfer probability was significantly associated with increasing age and comorbidity, and distance between the acute care trauma hospital and the nearest neurotrauma center, except for extreme NISSs.ConclusionsAcute care trauma hospitals managed a substantial burden of isolated moderate-to-severe TBI patients primarily and definitively, highlighting the importance of high-quality neurotrauma care in non-neurosurgical hospitals. The transfer probability declined with increasing age and comorbidity, suggesting that older patients were carefully selected for transfer to specialized care.

【 授权许可】

CC BY   
© The Author(s) 2023

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