Before trauma patients arrive in the emergency department, physicians use a set of trauma team activation criteria developed by the American College of Surgeons to identify which patients most urgently need intensive support upon arrival. These criteria enable emergency departments to mobilize and allocate trauma resources to patients who need rapid intervention. Currently, the criteria call for trauma team activation for traumatic brain injury (TBI) patients whose Glasgow Coma Scale (GCS) score is less than 9, indicating low responsiveness and potential loss-of-consciousness. However, some patients with severe TBI who need immediate intervention still score relatively high on the GCS scale, failing to meet the criteria that would trigger trauma team activation. Despite their urgent need for expedited intervention, these patients may have to wait to receive care upon arrival at the emergency department.
Among other early intervention services, TBI patients who quality for trauma team activation typically receive accelerated access to computed tomography (CT) scanning, a brain imaging technique that can detect brain swelling, bleeding, and other damage. Early CT scans enable clinicians to make rapid decisions about treatment, such as determining need for surgical intervention. Patients who do not meet criteria for trauma team activation may experience prolonged delays before receiving CT scans, potentially preventing them from receiving timely care.
A recent study sought to determine the impact of delayed head CT among patients with TBI. Researchers used the Trauma Quality Improvement Program databank to collect hospital records from nearly 5,000 patients who were admitted to the emergency department for TBI with a GCS score between 9 and 12. They studied each patient’s record to determine if they received immediate CT (within one hour of admission to the emergency department) or delayed CT (one to six hours after admission), using these data to analyze the effects of CT timing on other important health outcomes, such as timing of surgical intervention and length of hospital stay. The researchers found that:
- Patients who received delayed head CT also received delayed supportive care, including surgical intervention and intracranial pressure monitoring.
- Those who received delayed head CT spent nearly twice as long in the emergency department as those who received an immediate CT.
- There was no difference in mortality between patients who received immediate or delayed CT.
These results suggest that timing of head CT has no known negative effects on health outcomes after TBI. However, delayed head CT significantly extends patients’ length of stay in the emergency department, increasing both patient and hospital burdens such as increased cost, reduced capacity, and lost time. As a result, emergency health care providers are encouraged to implemented immediate head CT for all blunt trauma patients with moderate GCS scores, even if they do not meet criteria for trauma team activation.
Schellenberg M, Benjamin E, Owattanapanich N, et al. The impact of delayed time to first head CT in traumatic brain injury. European Journal of Trauma and Emergency Surgery. (June 2020).