Traumatic Brain Injury Care and Use of a Standardized Trauma Intake Form in Ghana

Care of patients with traumatic brain injury (TBI) is limited in many low- and middle-income countries because of constraints in expensive resources, including computerized tomography and neurosurgeons. Improving TBI care and outcomes should nonetheless be feasible by strengthening initial care to prevent secondary brain injury.

We conducted a post hoc analysis of a prior randomized trial at eight nontertiary hospitals in Ghana. The intervention was a quality-improvement tool, a standardized trauma intake form (TIF) with built-in real-time clinical decision support prompts. Outcomes were achievement of key performance indicators (KPIs) of trauma care and in-hospital mortality. In this post hoc analysis, we evaluated the association of the intervention with TBI care and outcomes.

A total of 4077 trauma patients were included. Of these, 252 had a head injury with abbreviated injury score (AIS) ≥ 2. TIF was associated with increased KPI achievement. In the before phase (n = 142), only three of 20 key KPIs were performed ≥ 90% of the time. After TIF introduction (n = 110), 18 of 20 KPIs were performed ≥ 90% of the time. For example, airway assessment rose from 79% to 98% (P = 0.015) and chest examination rose from 69% to 100% (P < 0.001). Similar patterns pertained to a subgroup with head AIS ≥ 3 (n = 79 before, n = 68 after). Mortality in the head AIS ≥ 3 group decreased from 34% to 19% (P = 0.009).

Many KPIs were suboptimal for TBI. The simple quality-improvement intervention, the TIF, was associated with increased KPI completion and with decreased mortality among more seriously head-injured patients (head AIS ≥ 3).