The impact of delayed time to first CT head on functional outcomes after blunt head trauma with moderately depressed GCS

Abstract

Purpose Recent work suggests patients with moderately depressed Glasgow Coma Scale (GCS) score in the Emergency Department (ED) who do not undergo immediate head CT (CTH) have delayed neurosurgical intervention and longer ED stay. The present study objective was to determine the impact of time to first CTH on functional neurologic outcomes in this patient population. Methods Blunt trauma patients presenting to our Level I trauma center (11/2015-10/2019) with first ED GCS 9-12 were retrospectively identified and included. Transfers and those with extracranial AIS ≥ 3 were excluded. The study population was stratified into Immediate (≤ 1 h) and Delayed (1-6 h) CTH groups based on time from ED arrival to first CTH. Outcomes included functional outcomes at hospital discharge based on the Modified Rankin Scale (mRS). Results After exclusions, 564 patients were included: 414 (73%) with Immediate CTH and 150 (27%) Delayed CTH. Both groups arrived with median GCS 11 and alcohol/drug intoxication did not differ (p > 0.05). AIS Head/Neck was comparable (3[3-4] vs. 3[3-3], p = 0.349). Time to ED disposition decision and ED exit were significantly shorter after Immediate CTH (2.

Undertriage of Severely Injured Trauma Patients

“…Severely undertriaged patients had higher initial systolic blood pressure in the field (137 [118-150] vs 116 [88-143] mmHg, P < .001) and in the ED (131 [116-149] vs 123 [76-148] mmHg, P < .001). Glasgow Coma Scale was also higher among SU patients (in the field, 15 [14][15] vs 6 [3][4][5][6][7][8][9][10][11][12][13][14], P < .001 and in the ED, 15 [14][15] vs 6 [3][4][5][6][7][8][9][10][11][12][13][14], P < .001). Severely undertriaged patients had a lower median ISS than AT patients (29 [26-30] vs 32 [27-41], P < .001).…”

“…9 The risk for poor outcomes among this group may be related to the delayed time to investigations, such as computed tomography scan of the head, and/or resultant delayed time to neurosurgical intervention. 10,11…”

“…9 The risk for poor outcomes among this group may be related to the delayed time to investigations, such as computed tomography scan of the head, and/or resultant delayed time to neurosurgical intervention. 10,11 Pulse pressure is an additional metric that may allow for the prehospital identification of patients who are otherwise stable but still stand to benefit from early mobilization of trauma center personnel and resources. Narrow pulse pressure in the field has been shown to indicate the likelihood of significant hemorrhage 12 and predicts the need for massive transfusion 13 and emergent intervention 14 in otherwise stable trauma patients.…”