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Prosser CJ, Edwards D, Boumara O, et al. Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients. Br J Neurosurg. 2020;1-7doi: 10.1080/02688697.2020.1858026.
Prosser, C. J., Edwards, D., Boumara, O., Fuller, G., Holliman, D., & Lecky, F. (2020). Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients. British journal of neurosurgery, 1-7. https://doi.org/10.1080/02688697.2020.1858026
Prosser, Callum J, et al. "Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients." British journal of neurosurgery vol. (2020): 1-7. doi: https://doi.org/10.1080/02688697.2020.1858026
Prosser CJ, Edwards D, Boumara O, Fuller G, Holliman D, Lecky F. Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients. Br J Neurosurg. 2020 Dec 16;1-7. doi: 10.1080/02688697.2020.1858026. Epub 2020 Dec 16. PMID: 33322927.
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Br J Neurosurg. 2020 Dec 16;1-7. doi: 10.1080/02688697.2020.1858026. Epub 2020 Dec 16.

Bypassing the nearest emergency department for a more distant neurosurgical centre in traumatic brain injury patients.

British journal of neurosurgery

Callum J Prosser, David Edwards, Omar Boumara, Gordon Fuller, Damian Holliman, Fiona Lecky

Affiliations

  1. Centre for Urgent and Emergency Care Research, University of Sheffield School of Health and Related Research, Sheffield, UK.
  2. Trauma Audit and Research Network, Clinical Science Building, Salford Royal Hospital, Salford, UK.
  3. Neurosurgery, Newcastle General Hospital, Newcastle, UK.

PMID: 33322927 DOI: 10.1080/02688697.2020.1858026

Abstract

BACKGROUND AND OBJECTIVE: Major trauma triage within regional trauma networks (RTN) select patients with suspected TBI for bypass to specialist neuroscience centres (SNC), expediting neurosurgical care but may delay resuscitation. This comparative effectiveness study assessed the impact of this strategy on the risk adjusted hospital survival rates of patients confirmed to have intracranial injury on brain computed tomography (CT) scan.

METHOD: A retrospective cohort study was conducted using Trauma Audit and Research Network trauma registry data. Adult patients with a TBI on CT scan were included if they presented between June 2015 to February 2016 to SNCs or non-specialist acute hospitals (NSAH) in the North of England (South Cumbria, Lancashire and the North East Region). Patients were identified as having bypassed a nearer NSAH emergency department (ED) to a SNC using google maps. Their standardised excess survival rate was compared to TBI patients who received primary treatment at a NSAH. A multivariate logistic regression model predicting 30-day survival after TBI (Ps14

STUDY DESIGN AND RESULTS: 355 patients met the study inclusion criteria, with 89/355 (25%) of TBI patients bypassing a nearer NSAH to a SNC, and 266/355 (75%) receiving primary treatment at an NSAH. The median severity of intracranial injury was equivalent (median Head Abbreviated Injury Scale 4 (IQR 4-5) in each group. There was no statistically significant difference in the standardised excess survival rate between the two cohorts; +6.15% for bypass (95% CI -1.24% to +13.55%) versus -1.12% for non-bypass (95% CI -4.51% to +2.25%).

CONCLUSION AND FUTURE RESEARCH: No statistically significant survival benefit was identified for TBI patients who bypassed the nearest ED to attend a SNC compared to those receiving treatment at the nearest NSAH, however a clinically significant 7% excess survival rate merits a larger study.

Keywords: Traumatic brain injury; bypass; neurosurgery; specialist neurological centre; trauma networks

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