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Time to Head Computed Tomography Protocol in Traumatic Brain Injury: A Quality Improvement Metric
Tareq Kheirbek1, Andrew R Luhrs1, Jayson Marawha1
1Alpert Medical School of Brown University, Providence, RI.
Background:
Early identification of traumatic brain injury (TBI) with head CT HCT should expedite operative decision-making and improve outcome. We aimed to determine whether an early HCT protocol in TBI patients would improve outcome.
Methods:
A multidisciplinary protocol to obtain an HCT within 30 minutes from arrival for patients with GCS ≤ 13 was instituted on 1/1/2015. Our trauma registry was queried for patients evaluated between 3/2012 and 12/2015. Outcomes included compliance with protocol and in-hospital mortality.
Results:
346 patients presented with GCS ≤ 13. Patients PRE- (n=264) and POST-protocol (n=82) were similar in demographic and physiologic characteristics. Time to HCT was lower (35 vs. 77 min; p<0.001). POST-protocol had lower odds of mortality (OR 0.65, 95% CI 0.43-0.99) adjusting for age, gender, ISS and GCS.
Conclusion:
Implementing a protocol of early HCT for TBI optimized performance of the trauma team. Time to HCT could serve as a quality metric in TBI.
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