Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center

ABSTRACT:This study assessed whether S-100β protein could be measured in urine when detectable in plasma after a mild traumatic brain injury (mTBI). Clinical data, plasma and urine samples were collected for the 46 adult patients prospectively enrolled in the emergency department (ED) of a Level 1 trauma center. S-100β protein concentrations were analysed using ELISA. S-100β protein was detectable in 91% and 71% of plasma and urine samples, but values were not correlated (r = 0.002). Urine sampling would have been a non-invasive procedure, but it does not appear to be useful in the ED during the acute phase after an mTBI.

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(A138) Duration of Emergency Department Stay and Injury Profile of Homeless Patients in a Level-1 Trauma Center

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001397 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s39-s39

Author(s):

S. Chauhan ◽

S. Bhoi ◽

D.T. Sinha ◽

M. Rodha ◽

L. Alexender ◽

...

Keyword(s):

Emergency Department ◽

Head Injury ◽

Trauma Center ◽

Injury Severity ◽

Road Traffic ◽

Road Traffic Crash ◽

Emergency Department Stay ◽

Level 1 ◽

Gcs Score ◽

Level 1 Trauma Center

Background and ObjectiveImmediate resuscitation and early disposition to definitive care improves outcomes. Homeless patients are neglected in emergency department (ED). The duration of ED stay and profile of injury of homeless patients at a Level-1 Trauma center were measured.MethodsThe study was performed from October 2008 to September 2009. Homeless patients were defined as patients who had no attendant and did not have any shelter. Duration of ED stay was noted from the ED arrival time to entry time at the definitive care (intensive care unit/ward). Clinical and demographic details were recorded. Subjects who had: (1) an attendant; (2) were discharged from the ED; or (3) expired in the ED were excluded.ResultsForty-one homeless patients were admitted. The mode of injury was road traffic crash in 73.2%; assault in 7.3%; fall from height in 7.3%; and in 12.2%, the mode of injury unknown. The average Injury Severity Score (ISS) was 6.76, with a maximum of 34 and minimum of 1. A total of 24 subjects (59%) had a Glasgow Coma Scale (GCS) score of ≤ 8 (severe head injury), 10 patients (24%) had GCS score 9–12 (moderate head injury), and seven subjects (17%) had GCS score 13–15 (minor head injury). Breath alcohol test was positive in 13%. The average duration of ED stay was 35 (3–173) hours in the homeless group and 12 (0.5–18) hours for patients with an attendant. Twenty-one subjects were admitted to neurosurgery (51.2%) with an average ED stay of 22.4 hours, five to surgery (12.20%) with average ED stay of 56.6 hours, and 15 to orthopedics (36.6%) with average ED stay of 45.3 hours.ConclusionsThe emergency department stay of homeless patients was 35 hours. Orthopedic trauma subjects had a prolonged disposal time. This addresses serious patient safety concerns and immediate remedial measures.

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External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma

Journal of Neurosurgery ◽

10.3171/2019.6.jns19584 ◽

2020 ◽

Vol 133 (6) ◽

pp. 1880-1885 ◽

Cited By ~ 1

Author(s):

Miner Ross ◽

Priscilla S. Pang ◽

Ahmed M. Raslan ◽

Nathan R. Selden ◽

Justin S. Cetas

Keyword(s):

Brain Injury ◽

Trauma Center ◽

Injury Severity ◽

Radiographic Progression ◽

Medical Intervention ◽

Neurosurgical Procedures ◽

Radiographic Findings ◽

Level 1 ◽

Level 1 Trauma Center ◽

Neurosurgical Intervention

OBJECTIVEConventional management of patients with neurotrauma frequently consists of routine, repeat head CT at preordained intervals with ICU-level monitoring, regardless of injury severity. The Brain Injury Guidelines (BIG) are a classification tool for stratifying patients into injury severity and risk-of-progression categories based on presenting clinical and radiographic findings. In the present study, the authors aimed to validate BIG criteria at a single level 1 trauma center.METHODSPatients were classified according to BIG criteria and evaluated for subsequent radiographic progression or development of neurological decline. A 2-year retrospective cohort review of consecutive patients with neurotrauma (n = 590) was undertaken. The authors then developed a modified BIG algorithm for use at their institution and followed its implementation prospectively over 555 consecutive patients.RESULTSIn the retrospective analysis, no patient in the BIG 1 category (n = 88, 14.9%) demonstrated progression or neurological decline, and 7.5% of BIG 2 patients (n = 107, 18.1%) demonstrated mild radiographic progression without any decline or need for additional neurosurgical or medical intervention, whereas 15.4% of BIG 3 patients (n = 395, 66.9%) underwent additional neurosurgical procedures. In the prospective analysis, no BIG 1 (n = 105, 18.9%) or BIG 2 (n = 48, 8.6%) patients demonstrated a clinical decline or required any further neurosurgical intervention. By contrast, 12.9% of BIG 3 patients (n = 402, 72%) required immediate neurosurgical intervention, and a further 2.0% required delayed intervention based on clinical and/or radiographic evidence of injury progression.CONCLUSIONSApplication of the BIG criteria in a single large level 1 trauma center reliably sorted patients into appropriate risk categories that accurately guided ongoing management.

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Validity of the Brief Test of Adult Cognition by Telephone in Level 1 Trauma Center Patients Six Months Post-Traumatic Brain Injury: A TRACK-TBI Study

Journal of Neurotrauma ◽

10.1089/neu.2020.7295 ◽

2020 ◽

Author(s):

Lindsay D. Nelson ◽

Jason K. Barber ◽

Nancy R. Temkin ◽

Kristen Dams-O'Connor ◽

Sureyya Dikmen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Trauma Center ◽

Post Traumatic ◽

Level 1 ◽

Level 1 Trauma Center ◽

Adult Cognition

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Early Prognostication after Traumatic Brain Injury: Specific Validation of the IMPACT Prognostic Calculator in a Level 1 Trauma Center

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685137 ◽

2019 ◽

Vol 80 (06) ◽

pp. 423-429

Author(s):

Anna Jung ◽

Felix Arlt ◽

Maciej Rosolowski ◽

Jürgen Meixensberger

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Trauma Center ◽

Roc Analysis ◽

Time Frame ◽

Extended Model ◽

Severe Tbi ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

AbstractThe present study evaluated the usefulness of the IMPACT prognostic calculator (IPC) for patients receiving acute neurointensive care at a level 1 trauma center in Germany. A total of 139 patients with traumatic brain injury (TBI) were assessed. One day after trauma, the extended model of the IPC was found to provide the most valid prediction of 6-month mortality/unfavorable outcome. Different time frames within the first day could be determined by analyzing mild, moderate, and severe TBI cohorts. The CORE + CT model at time frame Z2 (<6 h from the point of first documentation) for mild TBI exhibited the highest values in the receiver operating characteristic (ROC) analysis (area under the curve [AUC], 0.9; sensitivity, 1; specificity, 0.7). For patients with moderate head injury at time frame Z2/3 (<6–12 h from point of first documentation), the extended model fit best. For patients with severe TBI, the extended model at time frame Z6 (48–72 h from point of first documentation) best predicted 6-month mortality and unfavorable outcome (ROC analysis: AUC, 0.542/0.445; sensitivity, 0.167/0.364; specificity, 0.575/0.444). Center-specific validation demonstrated the validity of the IPC in the early phase after TBI. These findings support the usefulness of the IPC for predicting the prognosis of patients with TBI. However, further prospective validation using a larger TBI cohort is needed.

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Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center

Trauma ◽

10.1177/1460408620914436 ◽

2020 ◽

pp. 146040862091443

Author(s):

CE Dismuke-Greer ◽

SM Fakhry ◽

MD Horner ◽

TK Pogoda ◽

MJ Pugh ◽

...

Keyword(s):

Traumatic Brain Injury ◽

African American ◽

Brain Injury ◽

Military Service ◽

Trauma Center ◽

Mechanism Of Injury ◽

Level 1 ◽

Level 1 Trauma Center ◽

African American Race ◽

Hispanic White

Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans. Conclusions We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.

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