Emergency Department Time Course for Mild Traumatic Brain Injury Workup.

Document Type

Article

Publication Date

7-2018

Institution/Department

Emergency Medicine, Trauma & Acute Care Surgery

Journal Title

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

MeSH Headings

Emergency Service; Brain Concussion Therapy; Patient Discharge; Time Factors; Emergency Care; Human; Glasgow Coma Scale; Scales; Physicians, Emergency United States; United States; Nurses; Retrospective Design; Length of Stay; Patient Admission; Tomography, X-Ray Computed; Head Radiography

Abstract

Introduction: Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients. Methods: To examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13-15) - from initial presentation to the ED to discharge. Time spent at each step was estimated by a panel of United States emergency physicians and nurses. We subsequently validated time estimates using retrospectively collected, real-time data at two EDs. Length of stay (LOS) time differences between admission and discharged patients were calculated for patients being evaluated for mTBI. Results: Evaluation for mTBI was estimated at 401 minutes (6.6 hours) in EDs. Time related to head CT comprised about one-half of the total LOS. Real-time data from two sites corroborated the estimate of median time difference between ED admission and discharge, at 6.3 hours for mTBI. Conclusion: Limiting use of head CT as part of the workup of mTBI to more serious cases may reduce time spent in the ED and potentially improve overall ED throughput.

First Page

635

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