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Intensive Care Unit Admission Patterns for Mild Traumatic Brain Injury in the USA
Journal article   Open access   Peer reviewed

Intensive Care Unit Admission Patterns for Mild Traumatic Brain Injury in the USA

Robert H Bonow, Alex Quistberg, Frederick P Rivara and Monica S Vavilala
Neurocritical care, v 30(1), pp 157-170
Feb 2019
DOI: https://doi.org/10.1007/s12028-018-0590-0
PMID: 30136076
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1007/s12028-018-0590-0View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Adolescent Adult Age Factors Aged Aged, 80 and over Brain Concussion - therapy Child Child, Preschool Databases, Factual - statistics & numerical data Female Humans Infant Intensive Care Units - statistics & numerical data Male Medical Overuse - statistics & numerical data Middle Aged Patient Admission - statistics & numerical data Retrospective Studies Subarachnoid Hemorrhage - therapy Triage - statistics & numerical data Young Adult United States
Patients with mild traumatic brain injury (TBI) are frequently admitted to an intensive care unit (ICU), but routine ICU use may be unnecessary. It is not clear to what extent this practice varies between hospitals. We conducted a retrospective cohort study using the National Trauma Data Bank. Patients with at least one TBI ICD-9-CM diagnosis code, a head abbreviated injury score (AIS) ≤ 4, and Glasgow coma scale (GCS) ≥ 13 were included; individuals with only a concussion and those with a non-head AIS > 2 were excluded. Primary outcomes were ICU admission and "overtriage" to the ICU, defined by: ICU stay ≤ 1 day; hospital stay ≤ 2 days; no intubation; no neurosurgery; and discharged to home. Mixed effects multivariable models were used to identify patient and facility characteristics associated with these outcomes. A total of 595,171 patients were included, 44.7% of whom were admitted to an ICU; 17.3% of these met the criteria for overtriage. Compared with adults, children < 2 years were more likely to be admitted to an ICU (RR 1.21, 95% CI 1.16-1.26) and to be overtriaged (RR 2.06, 95% CI 1.88-2.25). Similarly, patients with isolated subarachnoid hemorrhage were at greater risk of both ICU admission (RR 2.36, 95% CI 2.31-2.41) and overtriage (RR 1.22, 95% CI 1.17-1.28). The probabilities of ICU admission and overtriage varied as much as 16- and 11-fold across hospitals, respectively; median risk ratios were 1.67 and 1.53, respectively. The likelihood of these outcomes did not vary substantially with the characteristics of the treating facility. There is considerable variability in ICU admission practices for mild TBI across the USA, and some of these patients may not require ICU-level care. Refined ICU use in mild TBI may allow for reduced resource utilization without jeopardizing patient outcomes.

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Critical Care Medicine
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