What are the demographic and clinical differences between those older adults with traumatic brain injury who receive a neurosurgical intervention to those that do not? A systematic literature review with narrative synthesis.

OBJECTIVES: This review aimed to identify the demographic and clinical differences between those older adults admitted directly under neurosurgical care and those that were not, and whether EMS clinicians could use these differences to improve patient triage. METHODS: The authors searched for papers that included older adults who had suffered a TBI and were either admitted directly under neurosurgical care or were not. Titles and abstracts were screened, shortlisting potentially eligible papers before performing a full-text review. The Newcastle-Ottawa Scale was used to assess the risk of bias. RESULTS: A total of nine studies were eligible for inclusion. A high abbreviated injury score head, Marshall score or subdural hematoma greater than 10 mm were associated with neurosurgical care. There were few differences between those patients who did and did not receive neurosurgical intervention. CONCLUSIONS: Absence of guidelines and clinician bias means that differences between those treated aggressively and conservatively observed in the literature are fraught with bias. Further work is required to understand which patients would benefit from an escalation of care and whether EMS can identify these patients so they are transported directly to a hospital with the appropriate services on-site.

Pre-hospital anaesthesia and assessment of head injured patients presenting to a UK Helicopter Emergency Medical Service with a high Glasgow Coma Scale: a cohort study.

OBJECTIVES: Patients who sustain a head injury but maintain a Glasgow Coma Scale (GCS) of 13-15 may still be suffering from a significant brain injury. We aimed to assess the appropriateness of triage and decision to perform prehospital rapid sequence induction (RSI) in patients attended by a UK Helicopter Emergency Medical Service (HEMS) following head injury. DESIGN: A retrospective cohort study of patients attended by Kent Surrey & Sussex Air Ambulance Trust (KSSAAT) HEMS. SETTING: A mixed urban and rural area of 4.5 million people in South East England. PARTICIPANTS: GCS score of 13, 14 or 15 on arrival of the HEMS team and clinical findings suggesting head injury. Patients accompanied by the HEMS team to hospital ('Escorted'), and those that were 'Assisted' but conveyed by the ambulance service were reviewed. No age restrictions to inclusion were set. PRIMARY OUTCOME MEASURE: Significant brain injury. SECONDARY OUTCOME MEASURE: Recognition of patients requiring prehospital anaesthesia for head injury. RESULTS: Of 517 patients, 321 had adequate follow-up, 69% of these were Escorted, 31% Assisted. There was evidence of intracranial injury in 13.7% of patients and clinically important brain injury in 7.8%. There was no difference in the rate of clinically important brain injury between Escorted and Assisted patients (p=0.46). Nineteen patients required an RSI by the HEMS team and this patient group was significantly more likely to have clinically important brain injury (p=0.04). CONCLUSION: In patients attended by a UK HEMS service with a head injury and a GCS of 13-15, a small but significant proportion had a clinically important brain injury and a proportion were appropriately recognised as requiring prehospital RSI. For patients deemed not to need a HEMS intervention, differentiating between those with and without clinically important brain injury appears challenging. LEVEL OF EVIDENCE: V.

Ambulance clinicians' perspectives of sharing patient information electronically.

INTRODUCTION: Communication in the NHS is vital to patient care and safety. Government bodies are pushing for the digitisation of patient health records so that access and transfer of information is easier between patient care teams. Many ambulance trusts have issued their clinical staff tablet computers as a step in the transition from paper-based to electronic-based patient health records. This study aims to evaluate whether these ambulance clinicians perceive tangible benefits to digitisation, particularly regarding collaborative working with other healthcare professionals. METHODS: Registered and non-registered clinical staff in one ambulance trust completed an online questionnaire utilising five-point Likert scales to collect data about their experiences of using electronic incident summary notifications to report back to the patient's GP, and on direct patient referrals to community teams for falls and hypoglycaemic episodes. Participants only completed questions relevant to the process they had experienced. RESULTS: From approximately 2115 members of staff eligible to participate, there were 201 respondents (9.50%) who provided information concerning GP summary notifications, fall referrals or hypoglycaemia referrals (n = 154, 76.62%; n = 178, 88.56%; n = 101, 50.25%, respectively).Overall, staff perceived the electronic communication of patient information as useful, but not essential, to their practice. The applications were seen as easy to use and a safer way to handle patient data. Though their use was felt to prolong the time spent on scene, this was regarded as an efficient use of a clinician's time.Many staff would prefer to talk directly to a patient's GP, but fewer felt that this was required for community referrals. While most participants did not feel obliged to send a GP summary notification of every encounter, the majority believed that the rates of appropriate falls and hypoglycaemia referrals would be improved with direct electronic communication.Respondents felt that recording and sharing patient information electronically improved collaborative working with other healthcare professionals, and they preferred having this ability. CONCLUSION: NHS ambulance trusts are transitioning to electronic patient records and this article suggests that ambulance staff are in favour of this transition when the technology is readily accessible and easy to use. Staff believe this approach is a safer way to store and share patient data and that collaborative working is enhanced. However, many clinicians would still prefer to discuss some incidents directly with a GP rather than sending a summary, highlighting the value staff place on real-time professional interaction when managing a patient.