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Head CT before Transfer Does Not Decrease Time to Craniotomy for TBI Patients.

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Head CT imaging at referring hospitals for traumatic brain injury patients did not speed up neurosurgical intervention. This pre-transfer radiography actually delayed care, underscoring the need for prompt transfer to trauma centers.

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Area of Science:

  • Trauma Surgery
  • Neurosurgery
  • Radiology

Background:

  • Rural trauma education advises against imaging if it delays definitive care.
  • Sharing radiographic images from referring hospitals (RH) could aid trauma centers (TC) in preparing for traumatic brain injury (TBI) patients.
  • The utility of pre-transfer head CT scans in accelerating neurosurgical intervention at TCs is unclear.

Purpose of the Study:

  • To evaluate if head CT imaging prior to transfer accelerates time to neurosurgical intervention at a trauma center.
  • To determine if pre-transfer radiography impacts the timeliness of care for traumatic brain injury patients.

Main Methods:

  • Retrospective review of trauma registry data from 2010-2015.
  • Inclusion criteria: TBI patients undergoing immediate neurosurgical procedures post-transfer from RH to a combined adult Level I/pediatric Level II TC.
  • Statistical analysis using ANOVA and chi-square to compare groups with and without RH imaging.

Main Results:

  • Eighty-six percent of 56 eligible TBI patients received head CT at the RH.
  • Eighteen percent of patients with GCS ≤8 received RH head CT.
  • No significant decrease in time to surgery was observed for patients imaged at RH; CT imaging was associated with >90-minute transfer delays.

Conclusions:

  • Imaging at referring hospitals delayed transfer to definitive care for TBI patients.
  • Pre-transfer head CT did not improve time to neurosurgical intervention at the trauma center.
  • Transfer to trauma centers should not be hindered by imaging, particularly for severe TBI cases.