Management of Adult Closed Head Injury in Rural Queensland Without Hospital-Based CT: A Retrospective Cohort Study

Area of Science:

• Emergency Medicine
• Neurotrauma
• Rural Health

Background:

• Rural emergency departments face unique challenges in managing adult closed head injuries.
• Limited access to in-hospital CT scanners impacts diagnostic pathways.
• Effective management requires careful consideration of imaging needs and transfer logistics.

Purpose of the Study:

• To evaluate the management, imaging pathways, and system challenges for adult closed head injury (CHI) patients.
• To assess the utilization of offsite and interhospital CT scans in a rural emergency department.
• To identify areas for improvement in patient safety and documentation.

Main Methods:

• Retrospective cohort study at Dalby Hospital (January 2022-January 2023).
• Inclusion of adult patients presenting with CHI, identified via ED Information System.
• Extraction of demographic, clinical, imaging, and disposition data from medical records.

Main Results:

• 118 patients included; 50.8% received CT head scans.
• CT scans were equally split between local offsite private radiology and interhospital transfer.
• Intracranial hemorrhage identified in 15% of imaged patients; documentation of observation and discharge advice was variable.

Conclusions:

• Rural EDs have substantial neuroimaging needs for CHI patients despite lacking hospital-based CT.
• Imaging relies on offsite or interhospital transfers, demanding careful pathway safety assessment.
• Variable documentation highlights a need to strengthen safety-netting protocols for rural head injury care.