Traumatic brain injury (TBI) is the leading cause of elderly trauma admissions. Previous research identified that each minute delay to TBI diagnosis was associated with a 2% mortality increase, delaying treatment to older patients (age ≥70 years) who do not meet trauma activation criteria. A TBI protocol and clinical decision support intervention (CDS-I) were developed to reduce time to imaging in older patients with head trauma not meeting trauma activation criteria.
An emergency department (ED) head CT protocol and CDS-I were developed and implemented to facilitate rapid imaging of older patients. Patients with TBI age ≥70 years and receiving anticoagulation met inclusion criteria. The primary outcome measure was time from ED arrival to head CT imaging comparing before (PRE: 1/1/2016-12/31/2016) vs after (POST: 8/1/2018-4/3/2019) protocol implementation. Negative binomial regression models evaluated the association of intervention on time to imaging. LOWESS smoothing was used to evaluate the association of intervention on mortality over time.
The study examined 451 patients (269 PRE and 182 POST). Positive head CTs were seen in 78 (17.3%). 57 of 78 (73%) had a GCS >13. POST-intervention decreased time to head CT from 56 to 27 minutes (IQR PRE: 32-93 to POST:16-44, p<0.001) and POST-intervention patients had reduced hospital length of stay (IRR 0.83, 95% CI 0.72-0.86, p=0.01).
A significant proportion of older patients receiving anticoagulation not meeting trauma activation criteria had positive CT findings. Implementation of a rapid triage protocol with CDS-I reduced time to imaging and may reduce mortality in the highest-risk populations.
Copyright © 2020. Published by Elsevier Inc.