gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Care paths and medical decision making in TBI patients presenting to the emergency department of a neurosurgical maximum care provider

Versorgungspfade und ärztliche Entscheidungsfindung bei Notfallpatienten mit Schädel-Hirn-Trauma an einer neurochirurgischen Universitätsklinik

Meeting Abstract

  • presenting/speaker Tamara Schink - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Shyrete Bahtijari - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Alexander Younsi - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV214

doi: 10.3205/22dgnc207, urn:nbn:de:0183-22dgnc2070

Veröffentlicht: 25. Mai 2022

© 2022 Schink et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Although diagnostic parameters for traumatic brain injury (TBI) are definite and the classification, based on the GCS score is well-defined, the medical management of especially milder cases of TBI relies on different, less clear-cut factors. Therefore, we aimed to describe care paths and medical decision making in TBI patients.

Methods: Patients with a suspected TBI, admitted to the ED of neurosurgical maximum care provider were prospectively assessed between April and December 2021. Demographics and clinical data were collected and the necessity for neuroimaging, admission to the regular ward or ICU and required medical or neurosurgical interventions were analyzed.

Results: Over a period of nine months, 781 TBI patients could be included (50% male; median age 50 (1-99) years). The most common cause of injury was an incidental fall (63%), typically happing in the home environment (40%). Nearly all patients (95%) presented with a mild TBI (GCS 13-15), and neurological deficits were rare (8%). Nevertheless, 132 patients (18%) suffered from amnesia and 110 (14%) had experienced vomiting. Anticoagulation was present in 25% of patients and 9% were under the influence of alcohol. Radiographs of the spine were taken in 126 patients (16%) and brain computed tomography (CT) imaging was performed in 66% of cases. Pathological intracranial findings were observed in 172 patients (34%). Interestingly, interventions were necessary for 662 patients (85%), including, among others, i.v.-analgesia (29%), superficial wound care (29%), antibiotic treatment (7%) and neurosurgery (6%). The decision for hospital admission was taken in 22% of cases with “pathological CT finding” being the most common indication (78%).

Conclusion: TBI patients presenting to a neurosurgical maximum care provider predominantly suffer from mild injuries. Nevertheless, the rate of brain CT imaging is high but similarly the rate of intracranial pathologies, suggesting adequate decision-making. Interventions typically pertain to pain and wound management and neurosurgery is rarely necessary. Considering the low hospital admission rate, overtreatment seems unlikely. A higher median age and frequent domestic falls might reflect the demographic change of TBI in Germany. Whether or not the COVID pandemic has affected those results needs to be further assessed.