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Reducing low-value interhospital transfers for mild traumatic brain injury.
Shen, Aricia; Mizraki, Nathaniel; Maya, Marcel; Torbati, Sam; Lahiri, Shouri; Chu, Ray; Margulies, Daniel R; Barmparas, Galinos.
Afiliação
  • Shen A; From the Department of Surgery (A.S., D.M., G.B.), Division of Acute Care Surgery and Surgical Critical Care, Department of Radiology (N.M., M.M.), Department of Emergency Medicine (S.T.), Department of Neurology (S.L.), Department of Biomedical Sciences (S.L.), and Department of Neurosurgery (S.L., R.C.), Cedars-Sinai Medical Center, Los Angeles, California.
J Trauma Acute Care Surg ; 96(6): 944-948, 2024 Jun 01.
Article em En | MEDLINE | ID: mdl-38523124
ABSTRACT

BACKGROUND:

The modified Brain Injury Guidelines (mBIG) were developed to stratify traumatic brain injuries (TBIs) and improve health care utilization by selectively requiring repeat imaging, intensive care unit admission, and neurosurgical (NSG) consultation. The goal of this study is to assess safety and potential resource savings associated with the application of mBIG on interhospital patient transfers for TBI.

METHODS:

Adult patients with TBI transferred to our Level I trauma center from January 2017 to December 2022 meeting mBIG inclusion criteria were retrospectively stratified into mBIG1, mBIG2, and mBIG3 based on initial clinicoradiological factors. At the time, our institution routinely admitted patients with TBI and intracranial hemorrhage (ICH) to the intensive care unit and obtained a repeat head computed tomography with NSG consultation, independent of TBI severity or changes in neurological examination. The primary outcome was progression of ICH on repeat imaging and/or NSG intervention. Secondary outcomes included length of stay and financial charges. Subgroup analysis on isolated TBI without significant extracranial injury was performed.

RESULTS:

Over the 6-year study period, 289 patients were classified into mBIG1 (61; 21.1%), mBIG2 (69; 23.9%), and mBIG3 (159; 55.0%). Of mBIG1 patients, 2 (2.9%) had radiological progression to mBIG2 without clinical decline, and none required NSG intervention. Of mBIG2, 2 patients (3.3%) progressed to mBIG3, and both required NSG intervention. More than 35% of transferred patients had minor isolated TBI. For mBIG1 and mBIG2, the median hospitalization charges per patient were $152,296 and $149,550, respectively, and the median length of stay was 4 and 5 days, respectively, with the majority downgraded from the intensive care unit within 48 hours.

CONCLUSION:

Clinically significant progression of ICH occurred infrequently in 1.5% of patients with mBIG1 and mBIG2 injuries. More than 35% of interfacility transfers for minor isolated TBI meeting mBIG1 and 2 criteria are low value and may potentially be safely deferred in an urban health care setting. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Centros de Traumatologia / Transferência de Pacientes Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Centros de Traumatologia / Transferência de Pacientes Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article