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

Jonathan J. Ratcliff, Opeolu Adeoye, Christopher J. Lindsell, Kimberly W. Hart, Arthur Pancioli, Jason T. McMullan, John K. Yue, Daniel Nishijima, Wayne A. Gordon, Alex B. Valadka, David O. Okonkwo, Hester F. Lingsma, Andrew I R Maas, Geoffrey T. Manley

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)844-850
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume32
Issue number8
DOIs
StatePublished - 2014

Fingerprint

Glasgow Coma Scale
Brain Concussion
Odds Ratio
Confidence Intervals
Skull Fractures
Intensive Care Units
Research
Inpatients
Intracranial Hemorrhages
Triage
Home Care Services
Craniocerebral Trauma
Anticoagulants
Hospital Emergency Service
Decision Making
Cohort Studies
Logistic Models
Tomography
Traumatic Brain Injury
Prospective Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

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. / Ratcliff, Jonathan J.; Adeoye, Opeolu; Lindsell, Christopher J.; Hart, Kimberly W.; Pancioli, Arthur; McMullan, Jason T.; Yue, John K.; Nishijima, Daniel; Gordon, Wayne A.; Valadka, Alex B.; Okonkwo, David O.; Lingsma, Hester F.; Maas, Andrew I R; Manley, Geoffrey T.

In: American Journal of Emergency Medicine, Vol. 32, No. 8, 2014, p. 844-850.

Research output: Contribution to journalArticle

Ratcliff, JJ, Adeoye, O, Lindsell, CJ, Hart, KW, Pancioli, A, McMullan, JT, Yue, JK, Nishijima, D, Gordon, WA, Valadka, AB, Okonkwo, DO, Lingsma, HF, Maas, AIR & Manley, GT 2014, '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', American Journal of Emergency Medicine, vol. 32, no. 8, pp. 844-850. https://doi.org/10.1016/j.ajem.2014.04.003
Ratcliff, Jonathan J. ; Adeoye, Opeolu ; Lindsell, Christopher J. ; Hart, Kimberly W. ; Pancioli, Arthur ; McMullan, Jason T. ; Yue, John K. ; Nishijima, Daniel ; Gordon, Wayne A. ; Valadka, Alex B. ; Okonkwo, David O. ; Lingsma, Hester F. ; Maas, Andrew I R ; Manley, Geoffrey T. / 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. In: American Journal of Emergency Medicine. 2014 ; Vol. 32, No. 8. pp. 844-850.
@article{cebc43ae58694734b53cae0b916dbaa3,
title = "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",
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.",
author = "Ratcliff, {Jonathan J.} and Opeolu Adeoye and Lindsell, {Christopher J.} and Hart, {Kimberly W.} and Arthur Pancioli and McMullan, {Jason T.} and Yue, {John K.} and Daniel Nishijima and Gordon, {Wayne A.} and Valadka, {Alex B.} and Okonkwo, {David O.} and Lingsma, {Hester F.} and Maas, {Andrew I R} and Manley, {Geoffrey T.}",
year = "2014",
doi = "10.1016/j.ajem.2014.04.003",
language = "English (US)",
volume = "32",
pages = "844--850",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "8",

}

TY - JOUR

T1 - ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient

T2 - Analysis of the Transforming Research and Clinical Knowledge in TBI study

AU - Ratcliff, Jonathan J.

AU - Adeoye, Opeolu

AU - Lindsell, Christopher J.

AU - Hart, Kimberly W.

AU - Pancioli, Arthur

AU - McMullan, Jason T.

AU - Yue, John K.

AU - Nishijima, Daniel

AU - Gordon, Wayne A.

AU - Valadka, Alex B.

AU - Okonkwo, David O.

AU - Lingsma, Hester F.

AU - Maas, Andrew I R

AU - Manley, Geoffrey T.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84905235172&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905235172&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2014.04.003

DO - 10.1016/j.ajem.2014.04.003

M3 - Article

C2 - 24857248

AN - SCOPUS:84905235172

VL - 32

SP - 844

EP - 850

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 8

ER -