173 Trauma Activations Are Associated with Decreased Time to Diagnosis & Treatment of Intracerebral Hemorrhage When Compared to Trauma Evaluations

Abstract

Intracerebral hemorrhage (ICH) is a major complication from traumatic brain injury. The 30-day mortality rate is 35-52%, with half occurring within 24 hours. Early diagnosis leads to early treatment and potentially better patient outcomes. To expedite patient care, when injury severity meets institutional criteria, a trauma activation is called. Trauma activations are immediately roomed and evaluated by a multispecialty resuscitation team. A trauma evaluation occurs when injuries do not meet trauma activation criteria. Instead patients are triaged and assigned a room as one becomes available. Trauma evaluations potentially have increased wait times and increased length of stay. The objective of this study was to evaluate whether or not trauma activation patients with ICH were diagnosed more rapidly than trauma evaluation patients and to assess the impact of this diagnosis on the time to treatment in this population. This was a retrospective cohort study of patients presenting to one of three trauma centers within a large hospital system between January 2018 and December 2018 who were diagnosed with acute traumatic ICH. Time to diagnosis, defined as minutes from patient arrival in the ED to computed tomography (CT) results received by treating provider, was evaluated between the two groups. Additional time points evaluated between groups were time to imaging, time to CT interpretation by radiology, and time to treatment of ICH. Demographics, patient medical history, and injury details were also abstracted. Categorical variables were described using frequencies and percentages and differences between groups were tested using Pearson chi-squared tests. Continuous variables are presented as median and standard deviation and differences between groups tested using t-tests. A total of 398 subjects met inclusion criteria for this study. Demographics and past medical history were similar and there was no difference in head abbreviated injury score, injury severity score, or anticoagulant use between groups. Trauma evaluation patients were older, predominately suffered a fall, and had an increased incidence of hypertension and chronic kidney disorder. Time to diagnosis was decreased for trauma activation compared to trauma evaluation patients (p<0.0001). Additionally, median treatment time for trauma activation was 107 minutes compared to 184.5 minutes for trauma evaluation patients (p-value < 0. 0001). Diagnosis and treatment times for traumatic intracerebral hemorrhage were significantly faster in trauma activation patients when compared to trauma evaluation patients. Given the similarities in injury severity between the two groups, the increased time of treatment could have detrimental impact on the treatment of patients. While trauma activations are a resource heavy process, our data suggests that an intermediary process may be beneficial.