ObjectiveWith the ageing population, the prevalence of mild traumatic brain injury (mTBI) among older patients is increasing, and the age criteria of the Canadian CT head rule (CCHR) is challenged by many emergency physicians. We modified the age criteria of the CCHR to evaluate its predictive capacity.MethodsWe conducted a retrospective cohort study at a level 1 trauma centre ED of all mTBI patients 65 years old and over with an mTBI between 2010 and 2014. Main outcome was a clinically important brain injury (CIBI) reported on CT. The clinical and radiological data collection was standardised. Univariate analyses were performed to measure the predictive capacities of different age cut-offs at 70, 75 and 80 years old.Results104 confirmed mTBI were included; CT scan identified 32 (30.8%) CIBI. Sensitivity and specificity (95% CI) of the CCHR were 100% (89.1 to 100) and 4.2% (0.9 to 11.7) for a modified criteria of 70 years old; 100% (89.1 to 100) and 13.9% (6.9 to 24.1) for 75 years old; and 90.6% (75.0 to 98.0) and 23.6% (14.4 to 35.1) for 80 years old. Furthermore, modifying the age criteria to 75 years old showed a reduction of CT up to 25% (n=10/41) among the individuals aged 65–74 without missing CIBI.ConclusionAdjusting the age criteria of the Canadian CT head rule to 75 years old could be safe while reducing radiation and ED resources. A future prospective study is suggested to confirm the proposed modification.
Introduction The availability, composition and activation criteria for trauma teams vary across different health care systems, but little is known about these features in the Canadian health system. The aim of this study is to provide a description of the current trauma team available in Level 1 and 2 centres across Canada. Methods In 2017, using a modified Dillman technique, a survey was sent to 210 health professionals across all Canadian trauma care facilities, including questions that focused on (1) the presence and the composition of a trauma team, (2) the established criteria to activate this team and (3) the initial patient care. Results Overall, 107 (57%) completed surveys were received. Only 22 (11.7%) were from Level 1 or 2 centre and considered for compilation. Seventeen respondents have a trauma team in their centre, and they all shared their criteria for activating their team (1–27 different indications). The suspected injuries, the judgment of the emergency physician, the systolic blood pressure, the Glasgow Coma Score and the respiratory rate were the most frequently mentioned items. In the presence of a pre-hospital care warning, the initial assessment of a severely injured patient is exclusively completed by a member of the trauma team for only 35.1% of the respondents. For 11.8% of respondents, trauma team coordinates airway management. For 64.7% of participants, the trauma team leader is the dedicated care provider to accompany patients until the final destination. Conclusions The results suggest a great variability across Canada, regarding the roles assumed by the trauma team but also regarding the activation criteria leading them to take action.
Introduction: It was demonstrated that the early trauma team activation (TTA) could improve younger trauma patients outcomes and mortality rates. However, the link between older patient prognosis improvement and the activation / effectiveness of the Trauma team (TT) is still unclear. There is also a lack of information about the exact and optimal structure of TTs and their activation criteria, which may differ across centers. The main objective of this study is to provide a description of the current TT available in level 1 and 2 centres across Canada. Methods: In 2017, a survey using a modified Dillman technique was sent to 210 health professionals scattered across all Canadian trauma care facilities. The survey included questions regarding 1) the presence and the composition of a TT, 2) the established TT activation criteria, and finally 3) the initial patient care. Results: A total of 107 (57%) completed surveys were received. Among them, only 22 (11.7%) were from level 1 or 2 centres and were therefore considered for analyses. Seventeen respondents had a TT in their centre, and they all shared their TT activation criteria (1 to 27 different indications). Most frequently mentioned criteria were: suspected injuries (58.8%), judgment of the emergency physician (41.2%), systolic blood pressure (47.1%), Glasgow Coma score (35.3%) and respiratory rate (28%). In presence of a prehospital care warning trauma, the initial assessment of a severely injured patient is exclusively completed by a member of the TT for only 35.1% of the respondents. For 11.8% of respondents, TT coordinates airway management. For 64.7% of participants, the TT leader is the dedicated care provider to accompany patients until final orientation. Conclusion: These results suggest a great variability across Canada regarding the roles assumed by the TT, but also regarding the activation criteria leading them to take action.
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