Should Patients with Severe Traumatic Brain Injuries be Initially Treated at the Closest Hospital or Transported Directly to a Neuroscience Centre? A Systematic Review
Authors List
Jones, B., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
Dicker, B., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, & Clinical Audit and Research Team, Hato Hone St John, Auckland, New Zealand
Howie, G., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
Todd, V., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
Introduction
Directly transporting severe traumatic brain injury (TBI) patients to a neuroscience centre (NC) is recommended. However, the closest hospital is rarely a NC, requiring emergency medical services (EMS) to bypass the local hospital. The aim of this review was to evaluate the effect transport to a NC had on mortality rates amongst adult patients with a severe TBI.
Methods
A systematic literature review was conducted using the databases Medline, CINAHL, Google Scholar and Cochrane. The inclusion criteria were: published between 2010 and 2023, adult patients (≥18) with severe TBI (Glasgow coma scale ≤8). The primary outcome studied was mortality. The secondary outcomes measured were the impact that subsequent transfer to a NC had on mortality, the delay subsequent transfer had on surgery, and the accuracy of EMS triage.
Results
The review identified seven studies. Four studies found increased mortality rates in patients directly transported to a NC, though none were statistically significant. EMS mistriage was uncommon and subsequently transferring mistriaged patients from a local hospital to a NC was significantly associated with reduced 24-hour and 30-day mortality in one study. Subsequent transfers prolonged delays to surgery in several studies but was not statistically significant.
Conclusion
This systematic review found subsequent transfer of severe TBI patients to a NC improved 24-hour and 30-day mortality rate. A subset of patients benefited from urgent neurosurgical surgery, as delays to surgery from subsequent transfers increased their mortality. EMS can accurately triage and transport patients with severe TBI. The skewing of more severely injured patients directly transported to a NC may mask any potential survival benefits of direct transport. Further research is needed to tease out potential differences in direct transport versus subsequent transfer to a NC for severe TBI patients. This review was limited to a small number of publications which suggests further research is needed.
Jones, B., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
Dicker, B., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, & Clinical Audit and Research Team, Hato Hone St John, Auckland, New Zealand
Howie, G., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
Todd, V., Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand
Introduction
Directly transporting severe traumatic brain injury (TBI) patients to a neuroscience centre (NC) is recommended. However, the closest hospital is rarely a NC, requiring emergency medical services (EMS) to bypass the local hospital. The aim of this review was to evaluate the effect transport to a NC had on mortality rates amongst adult patients with a severe TBI.
Methods
A systematic literature review was conducted using the databases Medline, CINAHL, Google Scholar and Cochrane. The inclusion criteria were: published between 2010 and 2023, adult patients (≥18) with severe TBI (Glasgow coma scale ≤8). The primary outcome studied was mortality. The secondary outcomes measured were the impact that subsequent transfer to a NC had on mortality, the delay subsequent transfer had on surgery, and the accuracy of EMS triage.
Results
The review identified seven studies. Four studies found increased mortality rates in patients directly transported to a NC, though none were statistically significant. EMS mistriage was uncommon and subsequently transferring mistriaged patients from a local hospital to a NC was significantly associated with reduced 24-hour and 30-day mortality in one study. Subsequent transfers prolonged delays to surgery in several studies but was not statistically significant.
Conclusion
This systematic review found subsequent transfer of severe TBI patients to a NC improved 24-hour and 30-day mortality rate. A subset of patients benefited from urgent neurosurgical surgery, as delays to surgery from subsequent transfers increased their mortality. EMS can accurately triage and transport patients with severe TBI. The skewing of more severely injured patients directly transported to a NC may mask any potential survival benefits of direct transport. Further research is needed to tease out potential differences in direct transport versus subsequent transfer to a NC for severe TBI patients. This review was limited to a small number of publications which suggests further research is needed.
