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Head CT before Transfer Does Not Decrease Time to Craniotomy for TBI Patients.

Abstract Rural trauma education emphasizes that radiologic imaging should be discouraged if it delays transfer to definitive care. With increased capacity for image sharing, however, radiography obtained at referring hospitals (RH) could help providers at trauma centers (TC) prepare for patients with traumatic brain injury. We evaluated whether a head CT prior to transfer accelerated time to neurosurgical intervention at the TC. The study was conducted at a combined adult Level I and pediatric Level II TC with a catchment area that includes rural hospitals within a 150 mile radius. The trauma registry was used to identify patients with traumatic brain injury who went to surgery for a neurosurgical procedure immediately after arrival at the TC. All patients were transferred in from a RH. Differences between groups were assessed using analysis of variance and chi-square. Fifty-six patients met study criteria during the study period (2010-2015). The majority (86%) of patients received head CT imaging at the RH, including a significant percentage of patients (18%) who presented with GCS ≤8. There was no statistically significant decrease in time to surgery when patients received imaging at the RH. CT imaging was associated with a delay in transfer that exceeded 90 minutes. Findings demonstrate that imaging at the RH delayed transfer to definitive care and did not improve time to neurosurgical intervention at the TC. Transfer to the TC should not be obstructed by imaging, especially for patients with severe TBI.
PMID
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Authors

Mayor MeshTerms

Craniotomy

Hospitals, Rural

Patient Transfer

Tomography, X-Ray Computed

Trauma Centers

Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 29580346
OWN - NLM
STAT- MEDLINE
DCOM- 20180404
LR  - 20180404
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 84
IP  - 2
DP  - 2018 Feb 1
TI  - Head CT before Transfer Does Not Decrease Time to Craniotomy for TBI Patients.
PG  - 201-207
AB  - Rural trauma education emphasizes that radiologic imaging should be discouraged
      if it delays transfer to definitive care. With increased capacity for image
      sharing, however, radiography obtained at referring hospitals (RH) could help
      providers at trauma centers (TC) prepare for patients with traumatic brain
      injury. We evaluated whether a head CT prior to transfer accelerated time to
      neurosurgical intervention at the TC. The study was conducted at a combined adult
      Level I and pediatric Level II TC with a catchment area that includes rural
      hospitals within a 150 mile radius. The trauma registry was used to identify
      patients with traumatic brain injury who went to surgery for a neurosurgical
      procedure immediately after arrival at the TC. All patients were transferred in
      from a RH. Differences between groups were assessed using analysis of variance
      and chi-square. Fifty-six patients met study criteria during the study period
      (2010-2015). The majority (86%) of patients received head CT imaging at the RH,
      including a significant percentage of patients (18%) who presented with GCS </=8.
      There was no statistically significant decrease in time to surgery when patients 
      received imaging at the RH. CT imaging was associated with a delay in transfer
      that exceeded 90 minutes. Findings demonstrate that imaging at the RH delayed
      transfer to definitive care and did not improve time to neurosurgical
      intervention at the TC. Transfer to the TC should not be obstructed by imaging,
      especially for patients with severe TBI.
FAU - Tonui, Peter M
AU  - Tonui PM
AD  - The Iowa Clinic, Des Moines, Iowa, USA.
FAU - Spilman, Sarah K
AU  - Spilman SK
FAU - Pelaez, Carlos A
AU  - Pelaez CA
FAU - Mankins, Mark R
AU  - Mankins MR
FAU - Sidwell, Richard A
AU  - Sidwell RA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Adult
MH  - Aged
MH  - Brain Injuries, Traumatic/*diagnostic imaging/surgery
MH  - *Craniotomy
MH  - Female
MH  - *Hospitals, Rural
MH  - Humans
MH  - Iowa
MH  - Male
MH  - Middle Aged
MH  - *Patient Transfer
MH  - Retrospective Studies
MH  - Time Factors
MH  - *Tomography, X-Ray Computed
MH  - *Trauma Centers
EDAT- 2018/03/28 06:00
MHDA- 2018/04/05 06:00
CRDT- 2018/03/28 06:00
PHST- 2018/03/28 06:00 [entrez]
PHST- 2018/03/28 06:00 [pubmed]
PHST- 2018/04/05 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2018 Feb 1;84(2):201-207.