Assessing geriatric patients with head injury in the emergency department using the novel level III trauma protocol - 13/07/21
, Shanna Jones, MD a, b, Aveh Bastani, MD a, b, Michael Opsommer, MD b, Ali Beydoun b, Patrick Karabon a, David Donaldson, DO bAbstract |
Introduction |
Intracranial injury in elderly patients presenting with minor head trauma is often overlooked in the emergency department (ED). Our suburban community-based level II trauma hospital developed and implemented the level III trauma protocol (L3TP) in January 2016 to better evaluate and diagnose intracranial injury in elderly patients presenting with minor head trauma after a fall. The L3TP requires that the ED physician immediately assess all patients meeting the following criteria 1) Age ≥ 65 years old. 2) Currently taking any anticoagulant or antiplatelet agents. 3) Presenting in the ED with a potential head injury after a fall. The ED physician determines if these high-risk patients require emergent imaging, obviating the need for trauma team activation unless an intracranial hemorrhage (ICH) is found. The purpose of this study was to assess the impact of the novel L3TP on resource utilization and patient outcome.
Methods |
Our retrospective cohort study included patients who met the L3TP inclusion criteria and had an ICH diagnosed by non-contrast computed tomography (CT). We compared patients triaged by the L3TP (January to December 2017) to patients triaged before the L3TP was implemented (January to August 2015) in order to assess the impact of the L3TP on resource utilization and patient outcome. The data was analyzed using two independent samples t-tests and Chi-square tests.
Results |
Patients triaged by the L3TP had a significantly shorter average length of time from arrival in the ED to CT (level III trauma 0.64 h vs control 2.37 h, (d = 1.73; 95% CI = 1.42, 2.04), p ≤ 0.0001) and ED length of stay (level III trauma 2.55 h vs control 4.72 h, (d = 2.17; 95% CI = 1.21, 3.13), p ≤ 0.0001). There was insufficient evidence to conclude that there was any difference in health outcomes between the control and level III trauma groups.
Conclusion |
The L3TP is an effective and resource efficient protocol that quickly identifies ICH in elderly patients without activating the trauma team for every elderly patient presenting to the ED with a potential head injury after a fall
Le texte complet de cet article est disponible en PDF.Highlights |
• | Level III trauma protocol identifies intracranial hemorrhage in geriatric patients. |
• | Level III trauma protocol reduces time from arrival in the ED to diagnosis. |
• | Level III trauma protocol is resource efficient. |
Keywords : Level III trauma protocol, Geriatric head injury, Intracranial hemorrhage
Plan
Vol 45
P. 149-153 - juillet 2021 Retour au numéro
Article précédent
- Capillary blood gas in infants with bronchiolitis: Can end-tidal capnography replace it?
- Andrea T. Vo, Deborah R. Liu, Anita R. Schmidt, Ara Festekjian
- Guillain-Barré syndrome in a patient previously diagnosed with COVID-19
- Alexandria C. Defabio, Thomas R. Scott, Robert T. Stenberg, Erin L. Simon
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?