A review of minor traumatic brain injury presentations and their management in Brisbane emergency departments

Abstract

Objective A retrospective audit of minor traumatic brain injury presentations to three Brisbane emergency departments aiming to assess rates of CT scans and compliance with the Canadian CT Head Rule (CCTHR), as well as reviewing the demographics of patients and their management. Method Minor traumatic brain injury presentations to the Emergency departments of the Royal Brisbane and Women’s Hospital, Redcliffe Hospital and Queen Elizabeth II Hospital between July 1st and August 30th, 2019 were identified via diagnosis searches in patient tracking systems. Data collected included patient demographics, use of CT scans and Abbreviated Westmead Post Traumatic Amnesia Scale assessment, length of stay and discharge advice regarding return to sport. Results 200 minor traumatic brain injury presentations were included. 75% of patients received a CT head with only 9% of these found to be non-compliant with the CCTHR. The most common indications for CTs were age >65, GCS <15 at 2 hours post injury and anticoagulation. Only 40% of patients that qualified for A-WTPAS received the assessment. 18% of presentations were due to sporting injuries and 69% were not given return to play advice. The average length of stay was 250 minutes with 41.5% of presentations longer than 4 hours. 99% of the patients were discharged home from the ED with 1% admitted. Conclusion The study characterised minor traumatic brain injury management across three emergency departments and showed that most patients received CT head scans that were indicated. However, other areas of management such as A-WPTAs and return to play advice must be improved.

Appropriateness of Computed Tomography Scan in Mild Traumatic Head Injury Among Adult Patients in Mulago National Referral Hospital, Uganda: a Cross-sectional Hospital Based Study

“…These ndings are in agreement with previous studies which also reported skull fractures as the most common abnormal CT scan nding in patients with mild head injury. This was found to be at 43% and 8.9% in studies done in Zagazig university, Egypt and in Brazil respectively (21,22). In our setting, skull fractures were the most common abnormal CT scan nding likely due to the mechanisms of injury involving motorcycle riders and assaults that are high risk factors for skull fractures.…”

“…However, two studies done in Brisbane Australia and Southern California showed comparable ndings to our study with the proportion of appropriate CT scans performed higher than the inappropriately performed CT scans. The proportions of appropriate CT scans based on the CCHR were found to be 91% and 63.2% for the study in Brisbane and Southern California respectively (22,23). For the study in Brisbane, CCHR had already been introduced for use in their ED and the study was assessing the compliance, this might explain the high proportion obtained.…”