scholarly journals Effects of the COVID-19 Pandemic on Treatment Efficiency for Traumatic Brain Injury in the Emergency Department: A Multicenter Study in Taiwan

2021 ◽  
Vol 10 (22) ◽  
pp. 5314
Author(s):  
Carlos Lam ◽  
Ju-Chuan Yen ◽  
Chia-Chieh Wu ◽  
Heng-Yu Lin ◽  
Min-Huei Hsu
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Surgical Management ◽  
Medical Records ◽  
Large Scale ◽  
Small Scale ◽  
Treatment Efficiency ◽  
Significant Delay ◽  
Viral Spread

The coronavirus disease 2019 (COVID-19) pandemic has impacted emergency department (ED) practice, including the treatment of traumatic brain injury (TBI), which is commonly encountered in the ED. Our study aimed to evaluate TBI treatment efficiency in the ED during the COVID-19 pandemic. A retrospective observational study was conducted using the electronic medical records from three hospitals in metropolitan Taipei, Taiwan. The time from ED arrival to brain computed tomography (CT) and the time from ED arrival to surgical management were used as measures of treatment efficiency. TBI treatment efficiencies in the ED coinciding with a small-scale local COVID-19 outbreak in 2020 (P1) and large-scale community spread in 2021 (P2) were compared against the pre-pandemic efficiency recorded in 2019. The interval between ED arrival and brain CT was significantly shortened during P1 and P2 compared with the pre-pandemic interval, and no significant delay between ED arrival and surgical management was found, indicating increased treatment efficiency for TBI in the ED during the COVID-19 pandemic. Minimizing viral spread in the community and the hospital is vital to maintaining ED treatment efficiency and capacity. The ED should retain sufficient capacity to treat older patients with serious TBI during the COVID-19 pandemic.

scholarly journals MP51: Assessment of predictors of deterioration in mild traumatic brain injury with intracranial hemorrhage at emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S60-S61
Author(s):  
É. Fortier ◽  
V. Paquet ◽  
M. Émond ◽  
J. Chauny ◽  
S. Hegg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Medical Records ◽  
Clinical Deterioration ◽  
Subdural Hemorrhage ◽  
Initial Symptom ◽  
Neurosurgical Intervention

Introduction: Mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH) is a common cause of Emergency Department (ED) visits. Over the past years, several authors have debated the relevance of radiological and clinical follow-up of these patients, as the main challenge is to identify patients at risk of clinical deterioration. Objectives: To determine whether demographic, clinical or radiological variables can predict patient deterioration. Methods: Design: An historical cohort was constituted in two level-1 trauma centers (Chu de Quebec - Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal)). Participants: Medical records of mTBI patients aged ⩾16 with an ICH were reviewed using a standardized data collection tool. Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation. Measures: Deterioration was defined as either death, deterioration of the control CT scan according to the radiologist, clinical deterioration or neurosurgical intervention. Analyses: Logistic regression analyses were performed to ascertain predictors of deterioration. Interobserver agreement was calculated. Results: A total of 274 patients were included in our analyses. Mean age was 60.8 and 68.9% (n = 188) were men. Four variables were found to be associated with all outcomes: radiological deterioration, clinical deterioration, death, and neurosurgical intervention. Diabetes (odds ratio (OR) = 2.6, 95% CI [0.97-6.94]), confusion as an initial symptom (OR = 2.8, 95% CI [1.42-5.61]), anticoagulation (OR = 2.8, 95% CI [1.01-7.84]) and significant subdural hemorrhage (≥4 mm) (OR = 3.4, 95% CI [1.42-5.61]) seen on the first computed tomography scan were strongly associated with these outcomes. Age had a neutral effect (OR = 1.01, 95% CI [0.99-1.03]) while high initial Glasgow Coma score seemed to have a protective effect (OR = 0.4, 95% CI [0.24-0.69]). Radiological deterioration was not systematically associated with clinical deterioration. As for the 46 patients with a deterioration of CT scan, only 30.4% vs. 69.5% without deterioration (p = 0.0035) showed a clinical deterioration. Conclusion: Diabetes, anticoagulation, significant subdural hemorrhage and confusion as an initial symptom seem to be predictors of deterioration following a mild traumatic brain injury with positive CT scan.

scholarly journals EFFICIENCY OF PRE-HOSPITAL DIAGNOSIS OF THE STROKE

2019 ◽  
Vol 20 (4) ◽  
pp. 19-24
Author(s):  
V. I. Gorbachev ◽  
A. M. Anuryev ◽  
I. L. Petrovа ◽  
I. A. Karetnikov ◽  
S. M. Gorbachevа ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Brain Neoplasms ◽  
Medical Records ◽  
Cerebrovascular Accident ◽  
First Aid ◽  
Case Histories ◽  
Vascular Center

Purpose of the study. To assess the quality of diagnosis cerebrovascular accident (CA) at the pre-hospital stage in patients brought to the regional vascular center.  Material and methods. 2708 case histories of the emergency department and accompanying sheets of first aid in patients with a guiding diagnosis of CA and 973 medical records of impatient in the regional vascular center were analyzed.  Results and conclusion. Of the 2708 patients admitted with a diagnosis of CA, 973 people were hospitalized. Among hospitalized patients, the diagnosis of stroke was confirmed in 96.5% of cases. The most frequent diseases that were mistakenly diagnosed as a stroke turned out to be: diabetes, traumatic brain injury and brain neoplasms, etc. Confirmation of the guiding diagnosis during self-circulation was 36.6%, when delivered by ambulance crews — 39.8%, air ambulance — 86.7% and by sanitary transport — 16.5% of cases.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

2020 ◽  
pp. 1-10
Author(s):  
Brittany M. Stopa ◽  
Maya Harary ◽  
Ray Jhun ◽  
Arun Job ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Data Bank ◽  
The United States ◽  
National Sample ◽  
Population Based ◽  
Weighted Estimates ◽  
True Incidence ◽  
Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

scholarly journals Engineered glycomaterial implants orchestrate large-scale functional repair of brain tissue chronically after severe traumatic brain injury

2021 ◽  
Vol 7 (10) ◽  
pp. eabe0207
Author(s):  
Charles-Francois V. Latchoumane ◽  
Martha I. Betancur ◽  
Gregory A. Simchick ◽  
Min Kyoung Sun ◽  
Rameen Forghani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Large Scale ◽  
Growth Factor Signaling ◽  
Neuronal Circuit ◽  
Reach To Grasp ◽  
Function Recovery ◽  
Cellular Repair ◽  
The Brain

Severe traumatic brain injury (sTBI) survivors experience permanent functional disabilities due to significant volume loss and the brain’s poor capacity to regenerate. Chondroitin sulfate glycosaminoglycans (CS-GAGs) are key regulators of growth factor signaling and neural stem cell homeostasis in the brain. However, the efficacy of engineered CS (eCS) matrices in mediating structural and functional recovery chronically after sTBI has not been investigated. We report that neurotrophic factor functionalized acellular eCS matrices implanted into the rat M1 region acutely after sTBI significantly enhanced cellular repair and gross motor function recovery when compared to controls 20 weeks after sTBI. Animals subjected to M2 region injuries followed by eCS matrix implantations demonstrated the significant recovery of “reach-to-grasp” function. This was attributed to enhanced volumetric vascularization, activity-regulated cytoskeleton (Arc) protein expression, and perilesional sensorimotor connectivity. These findings indicate that eCS matrices implanted acutely after sTBI can support complex cellular, vascular, and neuronal circuit repair chronically after sTBI.

scholarly journals Multisite medical record review of emergency department visits for traumatic brain injury

2021 ◽  
Vol 27 (S1) ◽  
pp. i42-i48
Author(s):  
Barbara A Gabella ◽  
Jeanne E Hathaway ◽  
Beth Hume ◽  
Jewell Johnson ◽  
Julia F Costich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Skull Fracture ◽  
Signs And Symptoms ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Intracranial Injury ◽  
Imaging Results ◽  
Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients

2020 ◽  
pp. 1-7
Author(s):  
Callum J. Prosser ◽  
David Edwards ◽  
Omar Boumara ◽  
Gordon Fuller ◽  
Damian Holliman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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