ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: analysis of the Transforming Research and Clinical Knowledge in TBI study☆☆☆
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Fig. 1
Univariable multinomial logistic regression results by ED disposition.
P < .05; $International normalized ratio; +Odds per year of education.
Fig. 2
Multivariable multinomial logistic regression results by ED disposition.
P < .05.
Abstract
Objective
Mild traumatic brain injury (mTBI) patients are frequently admitted to high levels of care despite limited evidence suggesting benefit. Such decisions may contribute to the significant cost of caring for mTBI patients. Understanding the factors that drive disposition decision making and how disposition is associated with outcomes is necessary for developing an evidence-base supporting disposition decisions. We evaluated factors associated with emergency department triage of mTBI patients to 1 of 3 levels of care: home, inpatient floor, or intensive care unit (ICU).
Methods
This multicenter, prospective, cohort study included patients with isolated head trauma, a cranial computed tomography as part of routine care, and a Glasgow Coma Scale (GCS) score of 13 to 15. Data analysis was performed using multinomial logistic regression.
Results
Of the 304 patients included, 167 (55%) were discharged home, 76 (25%) were admitted to the inpatient floor, and 61 (20%) were admitted to the ICU. In the multivariable model, admission to the ICU, compared with floor admission, varied by study site, odds ratio (OR) 0.18 (95% confidence interval [CI], 0.06-0.57); antiplatelet/anticoagulation therapy, OR 7.46 (95% CI, 1.79-31.13); skull fracture, OR 7.60 (95% CI, 2.44-23.73); and lower GCS, OR 2.36 (95% CI, 1.05-5.30). No difference in outcome was observed between the 3 levels of care.
Conclusion
Clinical characteristics and local practice patterns contribute to mTBI disposition decisions. Level of care was not associated with outcomes. Intracranial hemorrhage, GCS 13 to 14, skull fracture, and current antiplatelet/anticoagulant therapy influenced disposition decisions.
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☆This work was supported by: National Institutes of Health (Bethesda, MD)/National Institute of Neurological Disorders and Stroke: RC2NS069409 —“Transforming Research and Clinical Knowledge in TBI.” National Institutes of Health/National Institute of Neurological Disorders and Stroke: 5T32NS047996 —“Cerebrovascular Fellowship Training Program.”
☆☆This manuscript was an oral presentation at Society for Academic Emergency Medicine: Oral presentation on May 15, 2013 in Atlanta, GA.
