Isolated Versus Non-isolated Traumatic Brain Injuries Identification and Decision Making: A Comparative Study

Area of Science:

• Military Medicine
• Trauma Surgery
• Emergency Medicine

Background:

• Traumatic brain injury (TBI) is a leading cause of death in military settings.
• Prehospital diagnosis of TBI presents significant challenges for advanced life support (ALS) providers.
• TBI diagnosis is particularly difficult in combat environments.

Purpose of the Study:

• To compare prehospital and hospitalization characteristics of isolated versus non-isolated TBI.
• To evaluate the impact of coexisting injuries on TBI patient evaluation and outcomes.
• To analyze data from the Israeli Defense Forces Trauma Registry and Israeli National Trauma Registry (2006-2017).

Main Methods:

• Retrospective analysis of 885 TBI casualties.
• Categorization into isolated TBI (271 cases, 30%) and non-isolated TBI groups.
• Comparison of urgency assessments and missed diagnosis rates by ALS providers.

Main Results:

• Only 35% of isolated TBI cases were deemed urgent by ALS providers, compared to 67% in the non-isolated TBI group (P < 0.001).
• Missed TBI diagnoses by ALS providers occurred in 11% of isolated TBI cases versus 29% in the non-isolated TBI group.
• Concomitant injuries significantly affected the urgency classification and detection of TBI.

Conclusions:

• Coexisting injuries can delay TBI diagnosis by prehospital providers.
• Findings highlight the need for improved prehospital evaluation protocols for head injuries.
• Consideration of concomitant injuries may enhance care and improve outcomes for TBI patients.