Accuracy of Prehospital Head Injury Assessment: Emergency Medical Dispatcher Versus Emergency Department

In adult patients with head trauma, the location and characteristics of the visible head injury have been associated with adverse outcomes, such as traumatic intracranial hemorrhage and cervical spine injuries.

This study aimed to evaluate the reliability of head injury location and characteristics between Emergency Medical Dispatcher (EMD) and Emergency Department (ED) assessments in patients contacting an EMD for head injuries. A secondary objective was to assess how this reliability varied depending on the individual contacting the EMD.

This study was a planned sub-analysis of a multicenter, prospective, observational cohort study conducted over three 3 days in March 2023 in France (EPI-TC study). Main outcome was visible head injury location and characteristics. Standardized data collection occurred during the EMD call and upon ED admission. Interobserver reliability between EMD and ED assessments was measured using kappa coefficient.

Overall, 241 patients from 20 participating EMD and 20 EDs were included in this sub-analysis and most of them (79.3%) were community-dwelling patients. The EMD was most frequently contacted by unrelated witnesses (27.8%). Head injury location and characteristic were reliable between EMD and ED, with kappa coefficients of 0.76 (95% CI 0.73-0.79) and 0.76 (95% CI 0.72-0.81), respectively. However, this reliability was low when EMD was called by the patient himself (kappa coefficient 0.59 (95% CI 0.50-0.69) and 0.52 (95% CI 0.38-0.66) respectively).

In cases of head injuries, phone-based assessments by EMD regarding head injury location and characteristics are reliable in adult patients when reported by a witness. However, caution is recommended if the patients call the EMD themselves. In these cases, alternative evaluation methods could be considered, such as onsite assessment by a health care professional or telemedicine-based photographic transmission.