The faster the better? Time to first CT scan after admission in moderate-to-severe traumatic brain injury and its association with mortality

Abstract

Fast acquisition of a first computed tomography (CT) scan after traumatic brain injury (TBI) is recommended. This study is aimed at investigating whether the length of the period preceding initial CT scan influences mortality in patients with leading TBI. A retrospective cohort analysis of patients registered in the TraumaRegister DGU® was conducted including adult patients with TBI, defined as Abbreviated Injury ScaleHead ≥ 3 and GCS ≤ 13 who had been treated in level 1 or 2 trauma centers from 2007–2016. Patients were grouped according to time intervals either from trauma or from admission to CT. A total of 6904 patients met the inclusion criteria. Mean time period from trauma to hospital admission was 68.8 min. From admission to first CT, a mean of 19.0 min elapsed. Trauma severity was higher in groups with a longer duration from trauma to CT as represented by a mean (± standard deviation) Injury Severity Score (ISS) of 19.8 ± 9.0, 20.7 ± 9.3, and 21.4 ± 7.5 and similar distribution of mortality of 24.9%, 29.9%, and 36.3% in the ≤ 60-min, 61–120-min, and ≥ 121-min groups, respectively. An adjusted multivariable logistic regression model showed a significant influence of the level of the trauma center (p = 0.037) but not for interval from admission to CT (p = 0.528). TBI patients with a longer time span from trauma to first CT were more severely injured and demonstrated a worse prognosis, but received a CT scan faster when duration from admission is observed. The duration until the CT scan was obtained showed no significant impact on the mortality.

Association between Time to Emergent Surgery and Outcomes in Trauma Patients: A 10-Year Multicenter Study

“…These interventions can prolong the WEST, and accounting for them is crucial to accurately evaluating the effect of time to surgery. However, current studies supporting the golden hour concept often lack adjustment for these variables [ 14 , 24 ]. Finally, our findings may not be applicable to the general population.…”

Development of a quality indicator set for the optimal acute management of moderate to severe traumatic brain injury in the Australian context

“…Additionally, a reduction in the time to de nitive clinical management may reduce the incidence of physiological insults that have been shown to negatively in uence outcomes in msTBI 7 . While the evidence of bene t from faster transfer to trauma centres [22][23][24] and early CT scan 25,26 is mixed, much of the work in this area is limited by its retrospective nature, the use of mortality as the primary outcome and inadequate control for the multiple confounding factors associated with msTBI management. These methodological issues notwithstanding, the inclusion of time-based performance indicators is supported by a nationwide, multicentre, prospective study investigating the introduction of a set of msTBI treatment recommendations.…”

Early Pupillometry Assessment in Traumatic Brain Injury Patients: A Retrospective Study

“…The cornerstone of neuromonitoring in this setting remains neurological examination, which is often simplified using clinical scales, together with the initial assessment of brain injuries [ 3 , 4 ]. Moreover, the evaluation of pupillary function (i.e., pupillary size, symmetry and the pupillary light reflex, PLR) can give an estimation of brainstem function and/or impelling herniation (i.e., anisocoria, fixed mydriasis, lack of PLR) [ 5 , 6 ] and has been introduced into extensive prognostic calculators to predict 6-month mortality and neurological outcome in adult patients with moderate to severe TBI on admission [ 7 ].…”