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Traumatic Brain Injury: Does Admission Service Matter?
Manuel Castillo-Angeles1, Anupamaa J Seshadri2, Leo A Benedict3
1Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women''s Hospital, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Admission service for mild-to-moderate traumatic brain injury (TBI) impacts care processes, not mortality. Patients admitted to Neurosurgery received more CT scans and antiseizure medication, while Neurology/Medicine patients had less VTE prophylaxis compared to Trauma Surgery.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Neurology/Medicine
Background:
- Traumatic brain injury (TBI) is a common condition with considerable variation in care delivery across institutions.
- Patient admission to different services can influence treatment and outcomes.
- Understanding these variations is crucial for improving patient care.
Purpose of the Study:
- To evaluate differences in care and outcomes for patients with isolated mild-to-moderate TBI based on their admission service.
- To identify specific variations in medical management and interventions.
- To provide a foundation for evidence-based care protocols.
Main Methods:
- Retrospective study of adult patients with isolated mild-to-moderate TBI over three years.
- Exclusion of patients requiring neurosurgical intervention or with severe head injury (AIS ≥4).
- Comparison of outcomes (mortality, care markers) across three admission services: Trauma Surgery, Neurology/Medicine, and Neurosurgery, using multivariate analysis.
Main Results:
- No significant difference in in-hospital mortality was observed across the admission services.
- Patients admitted to Neurosurgery received more repeat head CTs and antiseizure medication without seizure.
- Patients admitted to Neurology/Medicine were less likely to receive venous thromboembolism chemoprophylaxis compared to Trauma Surgery.
Conclusions:
- Admission service significantly influences care processes for mild-to-moderate TBI patients.
- Identified variations in care metrics, including imaging, medication use, and prophylaxis, warrant further investigation.
- Findings support the need for protocolizing care for TBI patients to ensure consistent, evidence-based treatment.
