Blog Viewer

Intensive Care Unit Admission Patterns for Mild Traumatic Brain Injury in the USA

By Currents Editor posted 02-11-2019 14:11

  

By Robert H. Bonow, Alex Quistberg, Frederick P. Rivara, Monica S. Vavilala

Background

Patients with mild traumatic brain injury (TBI) are frequently admitted to an intensive care unit (ICU), but routine ICU use may be unnecessary. It is not clear to what extent this practice varies between hospitals.

Methods

We conducted a retrospective cohort study using the National Trauma Data Bank. Patients with at least one TBI ICD-9-CM diagnosis code, a head abbreviated injury score (AIS) ≤ 4, and Glasgow coma scale (GCS) ≥ 13 were included; individuals with only a concussion and those with a non-head AIS > 2 were excluded. Primary outcomes were ICU admission and “overtriage” to the ICU, defined by: ICU stay ≤ 1 day; hospital stay ≤ 2 days; no intubation; no neurosurgery; and discharged to home. Mixed effects multivariable models were used to identify patient and facility characteristics associated with these outcomes.

Results

A total of 595,171 patients were included, 44.7% of whom were admitted to an ICU; 17.3% of these met the criteria for overtriage. Compared with adults, children < 2 years were more likely to be admitted to an ICU (RR 1.21, 95% CI 1.16–1.26) and to be overtriaged (RR 2.06, 95% CI 1.88–2.25). Similarly, patients with isolated subarachnoid hemorrhage were at greater risk of both ICU admission (RR 2.36, 95% CI 2.31–2.41) and overtriage (RR 1.22, 95% CI 1.17–1.28). The probabilities of ICU admission and overtriage varied as much as 16- and 11-fold across hospitals, respectively; median risk ratios were 1.67 and 1.53, respectively. The likelihood of these outcomes did not vary substantially with the characteristics of the treating facility.

Conclusions

There is considerable variability in ICU admission practices for mild TBI across the USA, and some of these patients may not require ICU-level care. Refined ICU use in mild TBI may allow for reduced resource utilization without jeopardizing patient outcomes.

Read more

#NCJ

FURTHER READING
By: (from left to right) Sydney Moseley, MD, Hussein Alshammari, MD, Scott Woolf, DO, Fawaz Al-Mufti, MD 1 1 Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College The authors have no actual or potential conflict of interest in relation to ...
 By:  Danielle Marut, PharmD (left), Jessica Traeger, PharmD, BCCCP (right) The use of oral factor Xa inhibitors, including rivaroxaban and apixaban, has increased over the last several years. Historically, strategies for the treatment of bleeding patients taking these agents included supportive ...
By Bnar Shawki, MD, MBChB, F.I.C.M.S, FIPP, Head of Anesthesia Department in RozhHalat Emergency Hospital, Erbil, Iraq (left); Firas Abdulmajeed, MBChB, Assistant Professor of Critical Care Medicine and Neurology, University of Pittsburgh, USA (right) The population of Iraq is 37,203,000, according ...