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Evaluating mild traumatic brain injury management at a regional emergency department
  1. Ashlee Maree Brown1,
  2. Dara M Twomey1,
  3. Anna Wong Shee2
  1. 1 School of Health Sciences and Psychology, Federation University Australia, Ballarat, Victoria, Australia
  2. 2 School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
  1. Correspondence to Ashlee Maree Brown, School of Health Sciences & Psychology, Federation University Australia Mt Helen Campus, PO Box 663, Ballarat, VIC 3353, Australia; ashleembrown66{at}gmail.com

Abstract

Background Emergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas.

Aim The aim of this paper was to assess a regional health service’s adherence to their mTBI CPG.

Methods This was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation.

Results Fewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources.

Discussion/conclusion Several key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

  • brain concussion
  • brain injuries traumatic
  • emergency medical services
  • rural health services
  • practice guidelines

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethics approval was granted by the relevant health service and university human research ethics committees. 

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent Not required.

  • Contributors AWS and DMT conceived the study, contributed to the analysis plan and contributed to the writing of the paper. AMB collected the data, undertook the data analysis and had major responsibility for the writing of the paper.

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