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. 2021 Oct;44(5):2697-2706.
doi: 10.1007/s10143-020-01456-3. Epub 2020 Dec 18.

The faster the better? Time to first CT scan after admission in moderate-to-severe traumatic brain injury and its association with mortality

Marius Marc-Daniel Mader  1 , Roman Rotermund  1 , Rolf Lefering  2 , Manfred Westphal  1 , Marc Maegele  2   3 , Patrick Czorlich  4 ; TraumaRegister DGU
Affiliations

The faster the better? Time to first CT scan after admission in moderate-to-severe traumatic brain injury and its association with mortality

Marius Marc-Daniel Mader et al. Neurosurg Rev. 2021 Oct.

Abstract

Fast acquisition of a first computed tomography (CT) scan after traumatic brain injury (TBI) is recommended. This study is aimed at investigating whether the length of the period preceding initial CT scan influences mortality in patients with leading TBI. A retrospective cohort analysis of patients registered in the TraumaRegister DGU® was conducted including adult patients with TBI, defined as Abbreviated Injury ScaleHead ≥ 3 and GCS ≤ 13 who had been treated in level 1 or 2 trauma centers from 2007-2016. Patients were grouped according to time intervals either from trauma or from admission to CT. A total of 6904 patients met the inclusion criteria. Mean time period from trauma to hospital admission was 68.8 min. From admission to first CT, a mean of 19.0 min 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 ≤ 60-min, 61-120-min, and ≥ 121-min groups, 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). 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.

Keywords: Admission; Computed tomography; Mortality; Register; Trauma; Traumatic brain injury.

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Conflict of interest statement

Rolf Lefering declares that his institution (IFOM) has an ongoing service agreement with AUC GmbH, the owner of the TraumaRegister DGU database, which includes statistical support for scientific analyses using registry data. All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
The flowchart describes the exclusion and inclusion criteria. AIS Abbreviated Injury Scale, CT computed tomography, DGU German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie), GCS Glasgow Coma Scale
Fig. 2
Fig. 2
Distribution of times from admission of the patient until the CT scan. CT computed tomography
Fig. 3
Fig. 3
Line plot of times from admission and from trauma to CT in level 1 and 2 trauma centers. CT computed tomography
Fig. 4
Fig. 4
Mortality (bar with 95% confidence interval) and RISC-II prognosis (horizontal line) distributed on the time until the CT examination. RISC-II Revised Injury Severity Classification II
See this image and copyright information in PMC

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