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Multicenter Study
. 2024 Oct 29;24(1):207.
doi: 10.1186/s12873-024-01124-5.

Head injuries in prehospital and Emergency Department settings: a prospective multicenter cross-sectional study in France

Xavier Dubucs  1   2   3 , Thomas Lafon  4   5 , Romain Adam  6 , Solene Loth  6 , Flore Tabaka  7 , Florian Negrello  8   9 , Mustapha Sebbane  10 , Valerie Boucher  11 , Eric Mercier  11 , Marcel Émond  11 , Sandrine Charpentier  12   13   14 , Frederic Balen  12   14 ; EPI-TC IRU SFMU group
Collaborators, Affiliations
Multicenter Study

Head injuries in prehospital and Emergency Department settings: a prospective multicenter cross-sectional study in France

Xavier Dubucs et al. BMC Emerg Med. .

Abstract

Background: Head injuries are the leading cause of trauma in Emergency Departments (EDs). Recent studies have shown epidemiological changes in patients consulting ED for head injuries. The main objective of this study was to describe the profile of head injury patients consulting in the EDs in France and assess i) head injury severity across age groups; ii) the delay between the occurrence of head injury and ED arrival; iii) factors associated with traumatic intracranial hemorrhage (ICH).

Methods: This cross-sectional study collected patient data over a three-day period in March 2023. All adult patients (≥ 18 years old) admitted to the ED with a head injury (defined as a trauma to the head) were included. TBI severity was classified according to patients' initial Glasgow Coma Scale score in the ED: severe (3-8); moderate (9 -12); mild (13-15); and simple head trauma in the absence of transient or persistent neurological symptoms.

Results: Among the 71 participating EDs, 26,008 patients visited EDs and a total of 1070 patients (4.1%, IC 95 3.9-4.4) presented a head injury were included in the study, with a median age of 68.5 [37-85] years old. Most of the patients (66.7%) were referred to ED after a call to the Emergency Medical Dispatcher (EMD). The median time from head injury to ED visit was 2 h [1.0 - 5.5]. Ground-level falls were the leading cause of head injury (60.3%). Most of patient presented a simple head trauma (n = 715, 66.8%) followed by mild TBI (n = 337, 31.5%). CT head scans were performed for 636 patients (59.6%), of which 58 were positive. Traumatic ICH prevalence was 5.4% (95% CI: 4.1-6.9) and three patients (0.3%) required an urgent neurosurgical intervention. Neither preinjury anticoagulant (p = 0.97) nor antiplatelet (p = 0.93) use was associated with an increased risk of traumatic ICH.

Conclusions: One head injury patient out of two presenting in the ED is aged over 65 years. Patients referred by EMD were more likely to visit ED promptly. The majority of older patients underwent a head CT scan and preinjury anticoagulant use was not associated with increased risk of traumatic ICH.

Keywords: Emergency Department; Emergency Medical Dispatcher; Epidemiology; Head injury; Intracranial hemorrhage; Prehospital triage; Traumatic brain injury.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study investigating Emergency Departments
Fig. 2
Fig. 2
Patient care pathways
Fig. 3
Fig. 3
Traumatic brain injury severity and intracranial hemorrhage prevalence
See this image and copyright information in PMC

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