Analysis of Prehospital Transport of Head-Injured Patients after Consolidation of Neurosurgery Resources

Abstract

Unpredictable patient factors were the most frequent reasons patients required secondary transfer; few protocol violations or system factors were identified. No modifications to the current NS triage criteria are recommended.

Neurosurgical Emergency Transfers to Academic Centers in Cook County

“…Holmen et al (11) published a retrospective series of 82 patients with head injury in Alberta, Canada, who required transfer to a tertiary neurosurgical facility. They reported a median delay of 4 hours 22 minutes caused by the need for transfer.…”

A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes

“…The GCS is believed to assist with communication, 2,15,16 is known to affect decisions about intervention, 14,[17][18][19][20] and is used in many circumstances to allocate resources. 3,8,[21][22][23] This ubiquitous neurologic score has been incorporated into a number of clinical decision rules 17,24,25 and other trauma scores [26][27][28][29] and has become the undisputed criterion standard for traumatic brain injury assessment. 3 In this comparison of the total GCS to its 3 components and to 2 simplified scores in the prediction of traumatic brain injury outcome, we found the GCS to perform only marginally better than any of these alternatives, which implies considerable redundancy to the eye, verbal, and motor assessments of neurologic responsiveness and suggests that the common practice of totaling up scores for each of these 3 components may not add clinically important information to the use of a single component alone.…”

Prehospital Prediction of the Severity of Blunt Anatomic Injury

“…35 In a study evaluating the prehospital triage of head injuries directly to a neurosurgical center, a number of patients (69, 84% of transfers) who subsequently required secondary transfer for neurosurgical admission or operative intervention either failed to meet the direct triage criteria of a head injury and a GCS Ͻ14 and a Prehospital Index Ͼ3, or they had no history of a head injury according to the prehospital record. 36 In situations where anatomic injury severity is not clearly evident or confounded by other significant or distracting injuries, predicting severe anatomic injury is likely to be based on suspicion related to the causative mechanism. High suspicion of injury is employed as a method of triage in some systems with reported rates of 60% over-triage.…”