Article
The faster the better? Time to first CT scan after admission in moderate to severe traumatic brain injury and its association with mortality
Je schneller desto besser? Dauer bis zur ersten CT-Untersuchung nach Aufnahme bei Patienten mit mittelschweren und schweren Schädel-Hirn-Trauma und deren Einfluss auf die Mortalität
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Published: | June 4, 2021 |
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Objective: Fast acquisition of a first computed tomography (CT) scan after traumatic brain injury (TBI) is recommended. This study aims to investigate whether the length of the period preceding initial CT scan influences mortality in patients with leading TBI.
Methods: A retrospective cohort analysis of patients registered in the TraumaRegister DGU® was conducted. Adult patients with TBI, defined as Abbreviated Injury Scale (AIS) Head ≥3 and GCS ≤13 who had been treated in level 1 or 2 trauma centers between 2007 and 2016 were included. Patients were grouped according to time intervals either from trauma to CT or from admission to CT. In order to explore the influence of CT timing on mortality, standard mortality ratios (SMRs) were calculated for the different groups.
Results: A total of 6,904 patients met the inclusion criteria. Mean time period from trauma to hospital admission was 68.8min. From admission to first CT a mean of 19.0min elapsed. Trauma severity was higher in groups with a longer duration from trauma to CT as represented by a mean (± standard deviation) Injury Severity Score (ISS) of 19.8±9.0, 20.7±9.3 and 21.4±7.5 and similar distribution of mortality of 24.9%, 29.9% and 36.3% in the ≤60min-, 61-120min- and ≥121min-group, respectively. An adjusted multivariable logistic regression model showed a significant influence of the level of the trauma center (p=0.037) but not for interval from admission to CT (p=0.528).
Conclusion: TBI patients with a longer time span from trauma to first CT were more severely injured and demonstrated a worse prognosis, but received a CT scan faster when duration from admission is observed. The duration until the CT scan was obtained showed no significant impact on the mortality. It may be concluded that time management of TBI patients is adequate leading to timely initial diagnostic measures without causing harmful delay.